Evanson J A, Ikizler T A, Wingard R, Knights S, Shyr Y, Schulman G, Himmelfarb J, Hakim R M
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kidney Int. 1999 Apr;55(4):1501-8. doi: 10.1046/j.1523-1755.1999.00355.x.
Recent studies in patients with acute renal failure (ARF) have shown a relationship between the delivered dose of dialysis and patient survival. However, there is currently no consensus on the appropriate method to measure the dose of dialysis in ARF patients. In this study, the dose of dialysis was measured by blood- and dialysate-based kinetic methods in a group of ARF patients who required intermittent hemodialysis.
Treatments were performed using a Fresenius 2008E volumetric hemodialysis machine with the ability to fractionally collect the spent dialysate. Single-, double-pool, and equilibrated Kt/V were determined from the pre-, immediate post-, and 30-minute post-blood urea nitrogen (BUN) measurements. The solute reduction index was determined from the collected dialysate, as well as the single- and double-pool Kt/V.
Forty-six treatments in 28 consecutive patients were analyzed. The mean prescribed Kt/V (1.11 +/- 0.32) was significantly greater than the delivered dose estimated by single-pool (0.96 +/- 0.33), equilibrated (0.84 +/- 0.28), and double-pool (0.84 +/- 0.30) Kt/V (compared with prescribed, each P < 0.001). There was no statistical difference between the equilibrated and double-pool Kt/V (P = NS). The solute removal index, as determined from the dialysate, corresponded to a Kt/V of 0.56 +/- 0.27 and was significantly lower than the single-pool and double-pool Kt/V (each P < 0.001).
Blood-based kinetics used to estimate the dose of dialysis in ARF patients on intermittent hemodialysis provide internally consistent results. However, when compared with dialysate-side kinetics, blood-based kinetics substantially overestimated the amount of solute (urea) removal.
近期针对急性肾衰竭（ARF）患者的研究显示了透析剂量与患者生存率之间的关系。然而，目前对于测量ARF患者透析剂量的合适方法尚无共识。在本研究中，采用基于血液和透析液的动力学方法对一组需要间歇性血液透析的ARF患者的透析剂量进行了测量。
使用具有收集用过的透析液能力的费森尤斯2008E容量血液透析机进行治疗。根据血液尿素氮（BUN）的透析前、透析后即刻及透析后30分钟测量值确定单池、双池和平衡Kt/V。根据收集的透析液以及单池和双池Kt/V确定溶质清除指数。
对28例连续患者的46次治疗进行了分析。规定的平均Kt/V（1.11±0.32）显著高于单池（0.96±0.33）、平衡（0.84±0.28）和双池（0.84±0.30）Kt/V估计的实际透析剂量（与规定值相比，P均<0.001）。平衡Kt/V和双池Kt/V之间无统计学差异（P=无显著性差异）。根据透析液确定的溶质清除指数对应的Kt/V为0.56±0.27，显著低于单池和双池Kt/V（P均<0.001）。
用于估计间歇性血液透析的ARF患者透析剂量的基于血液的动力学方法提供了内部一致的结果。然而，与透析液侧动力学相比，基于血液的动力学方法大幅高估了溶质（尿素）的清除量。
