Ascend Clinical offers a variety of adequacy panels in LabCheck.
HEMODIALYSIS |
Kt/V Jindal (Not K/DOQI Recommended) | Jindal calculation Does not require draw information Includes Pre BUN, Post BUN, URR, Kt/V Jindal
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Kt/V Natural Log, URR (3x/wk) | Daugirdas II calculation Requires the following draw information (pre-weight, post-weight, treatment time) Includes Pre BUN, Post BUN, URR, UFR, Kt/V Natural Log - CMS requirement for patients dialyzing 3 times per week
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Kt/V Natural Log, URR, nPNA (3x/wk) | - Daugirdas II and Depner calculations
Requires the following draw information (pre-weight, post-weight, treatment time, treatment number for nPNA calculation) Includes Pre BUN, Post BUN, URR, UFR, Kt/V Natural Log, nPNA nPNA calculated from Kt/V without formal kinetic modeling by Depner and Daugirdas using thrice-weekly dialysis
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Kt/V Standard, URR (2 or 4-6x/wk) | - Leypoldt calculation
Requires the following draw information (pre-weight, post-weight, treatment time, number of treatments per week) Includes Pre BUN, Post BUN, URR, UFR, Kt/V Standard CMS requirement for patients dialyzing 2 or 4-6 times per week (Measures Assessment Tool)
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Kt/V Residual | Kt/V Residual calculated when Residual Urea Clearance ordered together with Kt/V Natural Log or Kt/V Standard; assesses total adequacy and is included on a patient report up to 90 days. Requires draw information: 24-hr urine collection time, urine volume, dry weight, height Includes Pre BUN, KrU, Urine Urea Nitrogen, Kt/V Residual
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PERITONEAL DIALYSIS |
PD Adequacy No Urine | Volume of Distribution (V): Hume and Weyers for Adult; Friis-Hansen for Peds <16 years Body Surface Area (BSA): Dubois and Dubois for Adult; Haycock for Peds <16 years - Protein Nitrogen Appearance (PNA): Bergstrom
Requires draw information (dry weight, height, 24-hr total drain volume) Includes Blood BUN, Blood Creatinine, Fluid Glucose, Fluid Urea Nitrogen, Fluid Creatinine, Weekly Dialysate Kt/V, Weekly Dialysate CrCl, nPNA
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PD Adequacy With Urine | - Volume of Distribution (V): Hume and Weyers for Adult; Friis-Hansen for Peds <16 years
Body Surface Area (BSA): Dubois and Dubois for Adult; Haycock for Peds <16 years Protein Nitrogen Appearance (PNA): Bergstrom Requires the following draw information (dry weight, height, total urine collection time, urine volume, 24-hr total drain volume) Includes Blood BUN, Blood Creatinine, Fluid Glucose, Fluid Urea Nitrogen, Fluid Creatinine,Urine Urea Nitrogen,Urine Creatinine,Weekly Dialysate Kt/V, Weekly Residual Kt/V, Weekly TotalKt/V, Weekly Dialysate CrCl, Weekly Residual GFR, Weekly Total CrCl, Weekly Residual CrCl, and nPNA
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FORMAL UREA KINETIC MODELING (UKM)
Formal Kinetic Modeling is also available in LabCheck for hemodialysis patients dialyzing 2-3 times per week. Per KDOQI, formal kinetic modeling provides a quantitative method for developing a treatment prescription for a specific patient. Formal UKM can be used to calculate the exact treatment time required to deliver a particular hemodialysis dose at specified blood and dialysate flows with a particular dialyzer.
RESOURCES
AJKD: https://www.ajkd.org/article/S0272-6386(15)01019-7/fulltext
CMS: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Dialysis.html
KDOQI: https://www.kidney.org/sites/default/files/docs/12-50-0210_jag_dcp_guidelines-hd_oct06_sectiona_ofc.pdf