Prediction and validation of hemodialysis duration in acute methanol poisoning
CCCF ePoster library. Lachance P. Oct 28, 2015; 114745; P124
Dr. Philippe Lachance
Dr. Philippe Lachance
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Abstract
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P124

Topic: Retrospective or Prospective Cohort Study

Prediction and validation of hemodialysis duration in acute methanol poisoning

Philippe Lachance, F. Mac-way, S. Desmeules, S. Deserres, A. Julien, P. Douville, M. Ganhoum, M. Agharazii

Nephrology, Laval University, Québec, Canada | Nephrology, Laval University, Québec, Canada | Nephrology, Laval University, Québec, Canada | Nephrology, Laval University, Québec, Canada | Plateforme de recherche clinique du CHU de Québec, Laval University, Québec, Canada | Biochemistry, Laval University, Québec, Canada | Nephrology, Université de Montréal, Verdun, Canada | Nephrology, Laval University, Quebec, Canada

Introduction: The duration of hemodialysis (HD) in methanol poisoning (MP) is dependent on the methanol concentration, the operational parameters used during HD and the presence and severity of metabolic acidosis. However, methanol assays are not easily available, potentially leading to undue extension or premature termination of treatment. Accuracy and safety of prediction models for HD duration have never been validated in a large number of cases of MP in the era of high-efficiency HD (1-2).

Objectives:

The aims of present study were 1) to use a training set of cases of MP in order to determine methanol elimination half-life during HD and to propose a simplified model to predict HD time and 2) to validate the proposed model using a validation cohort.



Methods: This is a retrospective single center study conducted at CHU de Québec-Hôtel Dieu de Québec Hospital (Quebec City, Canada). All adult cases of MP who were referred for HD from December 1997 to June 2013 and had a baseline methanol levels of > 10 mmol/l were eligible. Methanol elimination T1/2 for individual episodes of MP were calculated using serum methanol concentrations during HD and plotted through a one phase decay exponential regression analysis. In order to avoid selection bias and ensure the independence of observation, random MP episode, stratified for gender and excluding repeated MP of 28 patients (19 males), was used to construct a new model to predict the optimal HD duration in order to achieve a safe methanol concentration of < 6 mmol/l. Individual modeling of HD time to a safe methanol concentration of 6 mmol/l was obtained using each individuals elimination T1/2 Specified percentile Modeling of HD time was done using bootstrapping method. We used median, 75th and 90th percentiles of gender-specific T1/2 and sequentially targeted a final methanol concentration of 6, 5, 4, 3 and 2 mmol/l. The prediction model was confirmed in our validation set of MP (n=18).

Results: In 46 unique episodes of MP with high efficiency HD, methanol elimination half-life (T1/2) during HD was 108 min in women (95% CI: 95-121 min) and 127 min in men, respectively (95% CI: 123-136 min) (P=0.001). In a training set of MP (n=28), using the 90th percentile of gender-specific T1/2 (147 min in men and 141 min in women) and a target methanol concentration of 4 mmol/l (12.8 mg/dl), allowed all cases to reach a safe methanol of < 6 mmol/l (19.2 mg/dl). The prediction model was confirmed in our validation set of MP (n=18). In the validation set, the predicted HD duration was on average 56 minutes (95% CI: 5 ˗ 108) shorter than the delivered HD time.

Conclusion: In conclusion, our proposed approach to predict HD duration based on an elimination T1/2 (147 minutes in men, of 141 minutes in women) and targeting methanol concentration of 4 mmol/l in a s high-efficiency HD setting is expected to result in safely methanol concentration below 6 mmol/l, and potentially reduce HD time as compared to the current fashion of serial monitoring of the methanol concentrations during HD.

References: 1. Hirsch DJ, Jindal KK, Wong P, et al. A simple method to estimate the required dialysis time for cases of alcohol poisoning. Kidney Int 2001; 60: 2021-2024.
2. Youssef GM, Hirsch DJ. Validation of a method to predict required dialysis time for cases of methanol and ethylene glycol poisoning. Am J Kidney Dis 2005; 46: 509-511.
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