Yanai M, Boudier L, Lebkiri B, Takahashi S, Man N K
Département de Néphrologie, Hôpital Necker, Paris, France.
Nihon Jinzo Gakkai Shi. 1992 Jan;34(1):71-8.
Urea kinetic modeling (UKM) is often regarded as the best method for assessing the dialysis adequacy and consequently for the prescription of treatment time. However, other parameters are involved in the monitoring of end stage renal disease (ESRD) patients. Kt/V-urea and protein catabolic rate (pcr) were evaluated in 53 ESRD patients (25 males and 28 females; mean age, 60 +/- 2 years old; mean duration, 80 +/- 11 months), twice at an interval of 4 months, and pre-dialysis concentration of (pre-DC) plasma potassium, bicarbonate, calcium and phosphate were measured. The pre-dialysis systolic blood pressure and hematocrit were also recorded. The numbers of patients who were within the optimal range of Kt/V-urea and pcr recommended by Gotch and Sargent were 36 (67.9%) and 39 (73.6%), respectively, at the first control period, and 39 (73.6%) and 44 (83.0%) at the second control period. However, only about 50% of the patients were within the optimal range of pre-DC plasma calcium, phosphate and bicarbonate. Furthermore, very few patients fulfilled the conditions for all the parameters. It is concluded that (1) UKM is required to describe the domain of dialysis prescription, and (2) other parameters which are not dependent so much on dialysis should be taken into account for assessing the adequacy of dialysis.
尿素动力学建模（UKM）通常被视为评估透析充分性以及由此确定治疗时间处方的最佳方法。然而，终末期肾病（ESRD）患者的监测还涉及其他参数。对53例ESRD患者（25例男性和28例女性；平均年龄60±2岁；平均病程80±11个月）进行了Kt/V-尿素和蛋白质分解代谢率（pcr）评估，每隔4个月评估两次，并测量了透析前血浆钾、碳酸氢盐、钙和磷酸盐的浓度（透析前浓度）。还记录了透析前收缩压和血细胞比容。在第一个对照期，Kt/V-尿素和pcr处于Gotch和Sargent推荐的最佳范围内的患者人数分别为36例（67.9%）和39例（73.6%），在第二个对照期分别为39例（73.6%）和44例（83.0%）。然而，只有约50%的患者透析前血浆钙、磷酸盐和碳酸氢盐处于最佳范围内。此外，很少有患者所有参数都满足条件。结论是：（1）需要用UKM来描述透析处方范围；（2）评估透析充分性时应考虑其他不太依赖透析的参数。
