Lim P S, Lee H P, Kho B, Yu Y L, Chang S C, Lin Y Y, Yang C C, Wang T H, Kuo S Y, Lin L C
Department of Internal Medicine, Division of Nephrology Kuang Tien General Hospital, Taichung, Taiwan.
Blood Purif. 1999;17(4):199-205. doi: 10.1159/000014396.
On-line highflux hemodiafiltration (HDF) is a clinically interesting and effective mode of renal replacement therapy, which offers the possibility to obtain an increased removal of both small and large solutes. The fundamental role of urea kinetic monitoring to assess dialysis adequacy in conventional hemodialysis has been widely studied. Both direct measurement of the urea removed by the modified direct dialysate quantitation (mDDQ) based on partial dialysate collection (PDC) and dialysate-based urea kinetic modeling (DUKM) using urea monitor have been advocated. The validity of this assessment tool in the patients with on-line HDF remained unclear. The aims of this investigation were (1) to compare the delivered Kt/V, urea mass removal (UMR), solute removal index (SRI) and normalized protein catabolic rate (nPCR) between pre- and postdilutional high-flux HDF; (2) to verify and compare the efficiency of pre- and postdilutional HDF using DUKM with on-line dialysate urea sensor, and mDDQ with partial dialysate collection. During both mode of HDF, the paired analysis urea removed and Kt/V showed no significant difference. Using mDDQ, mean values for predilutional mode were as follows: Kt/V 1.53 +/- 0.01 UMR, 16.8 +/- 0.3 g/session; urea clearance 178 +/- 18 ml/min; SRI 75.5 +/- 7.7%; urea distribution volume (V) 28.3 +/- 1.2 liters; nPCR 1.34 +/- 0.18 g/kg/day; on the other hand, mean values for postdilutional mode were Kt/V 1.58 +/- 0.01; UMR 17.10 +/- 0.28 g/session; urea clearance 184 +/- 21 ml/min; SRI 77.2 +/- 3.5%; urea distribution volume, 27.8 +/- 1.5 liters; nPCR 1.34 +/- 0.19 g/kg/day. The mean value of urea generation rate was 5.82 +/- 1.12 mg/min during HDF. Our results showed that dialysis adequacy was achieved with both high-volume predilutional HDF and postdilutional HDF. These two modes of HDF provided similar and adequate small solute clearance. In addition, we found that on-line analysis of urea kinetics is a reliable tool for quantifying and assuring delivery of adequate dialysis.
在线高通量血液透析滤过（HDF）是一种具有临床意义且有效的肾脏替代治疗模式，它为增加对小分子和大分子溶质的清除提供了可能。尿素动力学监测在评估传统血液透析中透析充分性的重要作用已得到广泛研究。基于部分透析液收集（PDC）的改良直接透析液定量法（mDDQ）直接测量清除的尿素以及使用尿素监测仪的基于透析液的尿素动力学建模（DUKM）均被提倡。该评估工具在在线HDF患者中的有效性仍不明确。本研究的目的是：（1）比较前稀释和后稀释高通量HDF之间的透析剂量（Kt/V）、尿素清除总量（UMR）、溶质清除指数（SRI）和标准化蛋白分解代谢率（nPCR）；（2）使用在线透析液尿素传感器通过DUKM以及通过部分透析液收集使用mDDQ来验证和比较前稀释和后稀释HDF的效率。在两种HDF模式下，配对分析的尿素清除量和Kt/V均无显著差异。使用mDDQ时，前稀释模式的平均值如下：Kt/V为1.53±0.01，UMR为16.8±0.3g/次治疗；尿素清除率为178±18ml/min；SRI为75.5±7.7%；尿素分布容积（V）为28.3±1.2升；nPCR为1.34±0.18g/kg/天；另一方面，后稀释模式的平均值为Kt/V为1.58±0.01；UMR为17.10±0.28g/次治疗；尿素清除率为184±21ml/min；SRI为77.2±3.5%；尿素分布容积为27.8±1.5升；nPCR为1.34±0.19g/kg/天。HDF期间尿素生成率的平均值为5.82±1.12mg/min。我们的结果表明，大容量前稀释HDF和后稀释HDF均能实现透析充分性。这两种HDF模式提供了相似且充分的小分子溶质清除率。此外，我们发现尿素动力学的在线分析是量化和确保充分透析的可靠工具。
