Adimea®

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Adimea real-time monitoring process

Adimea enables the physician and care team to monitor the dialysis dose during therapy. This means the physician and care team are able to optimize the dialysis therapy parameters at any point during the course of the treatment.

The measured value gained directly from the spent dialysate can be used to determine the reduction in urinary excreted substances in the patient. Adimea is therefore a highly reliable and accurate means of determining current Kt/V values on an ongoing basis throughout the entire course of treatment.

Adimea is based upon the measurement of substances removed from the patient.

Adimea technology

The pioneering technology enables measurement in the spent dialysate. Because it continuously analyzes change in the molar concentration, Adimea is directly connected to the patient. On the basis of this characteristic, Adimea is a highly reliable and accurate instrument for an online determination of the current Kt/V value during treatment.

During therapy, the system - at the request of the user - generates a warning message in the event that the planned target value is not reached. This enables the user to carry out target-oriented adjustments to the treatment parameters – at any time during the ongoing dialysis. 

Adimea utilizes the principles of spectroscopy for determining the reduction in the molar concentration of urinary excreted substances in the dialysate drain. A light source transmits ultraviolet light  through the dialysate. The particles contained in the dialysate, which were removed from the plasma during dialysis, absorb the light. This absorption is measured by a sensor.

Principle 

It has been proven [1], that the UV absorption measurements can be used for determining the dialysis dose as there is a very close linear correlation between the measured UV absorption signal and the urea in the dialysate. For this reason, the measurement values recorded by Adimea can be used as replacement parameters for the urea.

Functionality during the treatment 

The progress of the measured substance reduction provides a true overview of the administered dialysis dose. Depending on the effectiveness of the dialysis, the concentration of urinary
excreted substances, and hence also the UV light absorption, reduces over the course of the treatment. The continual measurements result in a patient-specific curve which almost precisely corresponds to the reduction in urea.

Adimea processes this acquired information to determine, and clearly display, the Kt/V during treatment.

The dialysis progress becomes apparent quickly and easily. The graphic display of the treatment progress and relevant parameters (selected treatment index, Kt/V and URR, actual values achieved, overview of and access to: treatment time / blood flow / dialysate flow) enables optimum user support at all times.

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[1] Uhlin F, Fridolin I, Magnusson M, Linberg L-G. Dialysis dose (Kt/V) and clearance variation sensitivity using measurement of ultraviolet absorbance (on-line), blood urea, dialysate urea and ionic dialysance. Nephrol Dial Transplant (2006) 21: 2225-2231

Benefits of Adimea

Realization of the treatment objectives is therefore optimally supported by the device

Patient-specific factors influencing the treatment dose are also recorded by Adimea if applicable. This innovative measuring technology facilitates transparency of the dialysis treatment over the entire course of therapy. Necessary adjustments to the therapy parameters can be made at any time. The effects are immediately visible. Storage of the data on the patient treatment card also facilitates the analysis of dialysis dose over several treatments with the result that trends can be detected early.

Precise, innovative methods of real-time measuring

  • Precise and innovative means of determining reduction in urinary excreted substances in the patient
  • Real-time monitoring over the entire therapy duration through continuous measuring of effectiveness 

Clear and simple handling

  • No determination of V necessary – just the pre-dialysis weight
  • Configurable and clear display of URR, spKt/V, eKt/V and outcome prognosis
  • Changes can be made to the therapy parameters at any time 

Clinical results

Clinical trials [2] reveal a very close correlation between the laboratory-determined blood spKt/V and the spKt/V determined by Adimea. 

During a total of 64 treatments, blood was serially taken for urea testing to acquire a determination of the spKt/V from the blood as accurate as possible. The spKt/V value determined by Adimea was recorded at the same time.

The comparison of the data reveals, with r = 0.93 – an excellent correlation between the blood Kt/V and the Adimea Kt/V and hence a high degree of accuracy for the method. The measurement error recorded in these trials for the overall determination of the Kt/V is merely 7 %. Adimea – the technical innovation in Kt/V monitoring.

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[2] Werner, Günthner et al., B. Braun Avitum AG, Melsungen, 2009.

Dialysis dose Kt/V

Optimizing treatment quality

Chronic hemodialysis must be viewed as a medication which dose must be adjusted to the individual requirements of the patient. Large international studies [1; 2; 3; 4; 5; 6] have shown that the administered dialysis dose affects the long-term prognosis of the patient. 

Indicator for dialysis dose

The elimination of urinary excreted substances from the entire organism is crucial for the assessment of the adequacy of dialysis treatment. Urea is used as an indicator substance because of it‘s characteristics:

  • Distributed in all water in a patient's body
  • Balances out quickly any differences in concentration in different compartments
  • Can be almost completely eliminated in the dialyser due to its molecular size.

The elimination of urea from the organism during treatment therefore reflects dialysis adequacy. 

There are different methods to quantify urea clearance:

URR (Urea Reduction Ratio)
is the simplest way to determine the dialysis dose.
URR (%) = (C0 - Ct)/C0 x 100 

spKt/V (single-pool Kt/V)
takes both urea generation during dialysis and the effect of ultrafiltration into account.
spKt/V = - In (R - 0,008 x T) + (4 - 3,5 x R) x UF/W 

eKt/V (equilibrated Kt/V)
takes also urea rebound into consideration.
eKt/V = spKt/V - 0,6/T x spKt/V + 0,03

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