Tan H K, Bellomo R, M'Pis D A, Ronco C
Department of Intensive Care, Austin & Repatriation Medical Centre, Melbourne, Victoria, Australia.
Int J Artif Organs. 2001 Apr;24(4):186-91.
Achieving "adequacy of dialysis" includes the maintenance of normal serum phosphate concentrations and is an important therapeutic goal in the treatment of acute renal failure (ARF). It is unknown whether this goal is best achieved with intermittent or continuous renal replacement therapy.
We compared the effects of continuous veno-venous hemodiafiltration (CVVHDF) and intermittent hemodialysis (IHD) on serum phosphate concentrations using daily morning blood tests in 88 consecutive intensive care patients half of which were treated with IHD and half with CRRT RESULTS: Mean patient age was 54+/-14 years for IHD and 60+/-14 years for CVVHDF (NS). However, patients who received CVVHDF were more critically ill (mean APACHE II scores: 24.4+/-5.1 for IHD vs. 29.2+/-5.7 for CVVHDF, p<0.003). Before treatment, the serum phosphate concentration was 2.04+/-0.16 mmoll L for IHD and 1.96+/-0.17 mmoll L for CVVHDF (NS), with abnormal values in 79.4% of IHD patients and in 64.8% of CVVHDF patients (NS). During treatment, CVVHDF induced a greater reduction in serum phosphate (p=0.02) during the first 48 hours and conferred superior subsequent control of hyperphosphatemia (achieved in 64.6% of observations during CVVHDF vs. 41.8% during IHD; p<0.0001). The serum phosphate concentration was also more likely to be within the normal range during CVVHDF (55.3% vs.36.2%; p<0.0001). There was a trend toward more frequent hypophosphatemia (9.3% vs. 5.6%; P<0.1) during CVVHDF CONCLUSIONS: Abnormal serum phosphate concentrations are frequent in ARF patients before and during renal replacement, however, normalization of phosphatemia is achieved more frequently with CVVHDF.
实现“透析充分性”包括维持血清磷酸盐浓度正常，这是急性肾衰竭（ARF）治疗中的一个重要治疗目标。目前尚不清楚间歇性或连续性肾脏替代治疗能否最佳地实现这一目标。
我们对88例连续入住重症监护病房的患者进行每日晨间血液检测，比较连续性静脉-静脉血液透析滤过（CVVHDF）和间歇性血液透析（IHD）对血清磷酸盐浓度的影响，其中一半患者接受IHD治疗，另一半接受CRRT治疗。结果：IHD组患者平均年龄为54±14岁，CVVHDF组为60±14岁（无显著差异）。然而，接受CVVHDF治疗的患者病情更严重（平均急性生理与慢性健康状况评分系统II评分：IHD组为24.4±5.1，CVVHDF组为29.2±5.7，p<0.003）。治疗前，IHD组血清磷酸盐浓度为2.04±0.16 mmol/L，CVVHDF组为1.96±0.17 mmol/L（无显著差异），IHD组79.4%的患者和CVVHDF组64.8%的患者血清磷酸盐浓度异常（无显著差异）。治疗期间，CVVHDF在最初48小时内使血清磷酸盐降低幅度更大（p=0.02），并在随后对高磷血症的控制方面更具优势（CVVHDF期间64.6%的观察结果达到目标，IHD期间为41.8%；p<0.0001）。CVVHDF期间血清磷酸盐浓度也更有可能处于正常范围内（55.3%对3.%；p<0.0001）。CVVHDF期间有出现更频繁的低磷血症的趋势（9.3%对5.6%；P<0.1）。结论：ARF患者在肾脏替代治疗前及治疗期间血清磷酸盐浓度异常很常见，然而，CVVHDF更常使血磷水平恢复正常。
