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Medical Decision Making
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Improvement of Decisions Regarding Hemodialysis Patients by Urea Kinetic Modeling

Tom Buur, MD

Toomas Timpka, MD, PhD

The potentials for improving decisions about adequacy of dialysis (AD) and daily protein intake (DPI) by urea kinetic modeling (UKM) were examined. Four nephrologists evaluated AD, DPI, and metabolic stability in 62 patients. UKM was done three times; but the results were not revealed. Clinicians' decisions were then compared with UKM measures of effective dialysis (Kt/V) and protein catabolic rate (pcr). Detection of inadequately treated patients by the clinicians was poor (28%, Kt/V < 1.0; and 40%, Kt/V < 0.9). Specificities of the clinicians' decisions were 0.96 and 0.92, respectively. Combining pcr and consensus decisions, 59 patients could be assigned a probable DPI. Using this as "gold standard," the average clinician detected 77% of 13 low DPls. Single or triple pcr determinations alone detected 77% or 62%, respectively. Specificities were 0.91, 0.85, and 1.0. Simulated decision making suggested that combining pcr with clinical evaluation in a logical way would lead to detection of most patients with low DPI. Qualitative data from individual patient cases causing con troversies are presented and discussed. It is concluded the UKM should be used routinely to assess the adequacy of dialysis and daily protein intake.

Key Words: Key words: computer • decision making • hemodialysis • practice research • urea kinetic modeling. (Med Decis Making 1990;10:274-282)

Medical Decision Making, Vol. 10, No. 4, 274-282 (1990)
DOI: 10.1177/0272989X9001000405
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