The European Renal Calculator (EuReCa) app: a user-friendly tool for calculating dialysis dose in incremental hemodialysis

BACKGROUND: Incremental hemodialysis (HD) can exploit the presence of renal urea clearance (KRU) to reduce the frequency and/or dose of HD but must ensure adequate total weekly clearance, expressed as the so-called Continuous Equivalent Clearance (ECC). The aim of this study was to provide an app that could help the nephrologist prescribe dialysis parameters to achieve the appropriate ECC based on the patient's KRU. METHODS: Recently, we designed a user-friendly tool for calculating dialysis dose in incremental HD which consists of a few rows of a common spreadsheet. We named it SPEEDY. It is able to provide results that are superimposable to those of Solute-Solver, the software recommended by the KDOQI clinical practice guidelines for HD adequacy. However, there were still difficulties with SPEEDY in calculating the dialysis dose to be prescribed in a timely manner. Therefore, we developed new formulas able to overcome this problem in the incremental HD setting. RESULTS: These new formulas have been utilized to build up the European Renal Calculator (EuReCa) app, freely available at https://clearance.streamlit.app. It is intended exclusively for nephrologists treating adult patients on maintenance HD. EuReCa app is made up of five modules with related instructions for users. It allows to choose and share with the patient the prescription of treatment frequency, dialysis dose, session length, dialyzer clearance, dialyzer device, blood flow rate, ultrafiltration rate, and protein intake. CONCLUSION: The EuReCa app provides guidance on prescribing key HD operating parameters. Therefore, it is particularly useful for prescribing and assessing incremental HD.