PubMed · 5894840
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M Saito. 1965. [Tests for urea nitrogen].. https://pubmed.ncbi.nlm.nih.gov/5894840/
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Urea removal by continuous ambulatory peritoneal dialysis (CAPD) was compared with that by hemodialysis (HD) using a mathematical kinetic model. The time-averaged urea-nitrogen concentration (TAC) in the blood of a patient on maintenance HD was calculated by the model. Clearance with HD giving a TAC value equal to the constant urea-nitrogen concentration in the blood of a patient on CAPD was obtained, leading to the relation of equivalent clearances between HD and CAPD on the assumption that the urea-generation rate of the patient on CAPD was equal to that of the patient on HD.
Our current understanding of how dialysis should be measured and optimized evolved from several painful lessons. The pain was felt by patients who were passive recipients of treatments that were often limited by the toxic effects of acetate, attempts to shorten treatment time, and adverse effects of the membranes. Pain was also felt by caregivers who were burdened by the complications of inadequate dialysis that required their efforts and vigilance. Early efforts to quantify dialysis by controlling the serum urea concentration were replaced by methods to control the dialyzer urea clearance expressed per dialysis and factored for the patient's size (Kt/V). This understanding resulted largely from data collected during US National Cooperative Dialysis Study in the late 1970s, but it took several years for the lesson to become a standard of practice. We continue to struggle with our understanding of uremic toxins and how best to remove them. The future promises to resolve the age-old question of toxicity and to give us a better perspective on the effects of protein catabolism, residual renal clearance, and both dialysis duration and frequency. Other factors yet to be explored may ultimately impact on the requirement for dialysis and allow better tailoring of treatment to individual needs.
Benchmarks for timeliness of early morning routine clinical laboratory tests were developed from over 17,000 urea nitrogen and 16,000 white blood cell count measurements made for inpatients in 653 institutions participating in the College of American Pathologists Q-Probes program. Urea nitrogen and white blood cell counts were considered surrogates for routine chemistry and hematology tests. Laboratories at the 50th percentile reported median urea nitrogen and white blood cell counts by 09.04 and 08.51 h, respectively, whereas those at the 10th percentile reported these median measurements by 11.30 and 11.18 h, respectively. Results were available sooner in non-teaching than teaching institutions, and in smaller rather than larger institutions, with the degree of computerization affecting test availability. Timeliness also was affected by instrument type and mode of operation, but was unaffected by the percentage of stat testing. Based on modeling by regression analysis, there was little evidence that longer routine test turnaround times affect patient length of stay.