Maduell F, Puchades M J, Navarro V, Torregrosa E, Rius A, Sánchez J J
Servicio de Nefrología, Hospital General de Castellón, Castellón.
Nefrologia. 2005;25(5):521-6.
Until now, with the ionic dialysance measurement, it has been possible to determine hemodialysis dose in each session of hemodialysis (HD) and in the conventional hemofiltration (HDF) but not in the modality of on-line HDF. Recently it is possible with a new biosensor that allows to measure the dose in on-line HDF. The aim of this study was to evaluate the value of this biosensor in different dialysis situations comparing the dialysis dose measured in blood in comparison with the values obtained from the sensor. We have analysed 192 hemodialysis sessions performed in 24 patients, 15 male and 9 female, mean age of 70.2 +/- 12 years, included in on-line HDF. All treatments were done using 4008H (Fresenius) monitor equipped with on-line clearance monitoring (OCM), that measure, with non invasive monitoring, the effective ionic dialysance equivalent to urea clearance. Every patient received eight dialysis sessions: one with dialysate flow (Qd) 500 ml/min, two with HD and Qd 800 ml/min and five with on-line HDF. Other habitual haemodialysis parameters were no changed, dialysis time 200 +/- 63 min (135-300) and blood flow 421 +/- 29 ml/min (350-450). Initial and final ionic dialysance values (K), final Kt, Kt/V measured with OCM using V of Watson, and Kt/V determined in blood pre and postdialysis concentrations of urea (Daugirdas second generation), were measured. The mean of initial K was 251 +/- 21 ml/min and the final K was 234 +/- 24 ml/min. The Kt measured with OCM was 50.6 +/- 17 L, 51.2 +/- 17 in men and 49.7 +/- 16 in women. The V (Watson) was 34.5 +/- 6 L. The Kt/V measured with the Kt of OCM and V was 1,499 +/- 0.54 and Kt/V measured in blood samples was 1,742 +/- 0.58. The correlation between both values was 0.956. The Kt was different according to dialysis modality used: in HD and Qd 500 was 44.7 +/- 15 L, in HD and Qd 800 was 50.7 +/- 17 and in on-line HDF (22.1 +/- 7 L of reposition volume), was 51.8 +/- 17 L. The Kt/V from blood samples also shows variation: in HD and QD 500 was 1.60 +/- 0.55, in HD and Qd 800 was 1,726 +/- 0.56 and in on-line HDF was 1,776 +/- 0.59. In this study has been observed a close correlation between the new biosensor OCM with the measures obtained from the blood samples. For this reason this sensor it is useful in all modalities of dialysis treatment, included on-line HDF. The sensor was able to discriminate the efficacy of different dialysis modalities used in this study.
到目前为止，通过离子透析率测量，可以在每次血液透析（HD）和常规血液滤过（HDF）过程中确定血液透析剂量，但在线HDF模式下不行。最近，一种新的生物传感器能够在在线HDF中测量剂量。本研究的目的是通过比较血液中测量的透析剂量与传感器获得的值，评估这种生物传感器在不同透析情况下的价值。我们分析了24例患者（15例男性和9例女性，平均年龄70.2±12岁）进行的192次在线HDF血液透析治疗。所有治疗均使用配备在线清除率监测（OCM）的4008H（费森尤斯）监测仪，该监测仪通过非侵入性监测测量等同于尿素清除率的有效离子透析率。每位患者接受八次透析治疗：一次透析液流量（Qd）为500 ml/min，两次HD且Qd为800 ml/min，五次在线HDF。其他常规血液透析参数不变，透析时间为200±63分钟（135 - 300分钟），血流速度为421±29 ml/min（350 - 450 ml/min）。测量了初始和最终离子透析率值（K）、最终Kt、使用沃森公式的V通过OCM测量的Kt/V以及通过透析前后血液中尿素浓度（达吉尔达斯第二代公式）确定的Kt/V。初始K的平均值为251±21 ml/min，最终K为234±24 ml/min。通过OCM测量的Kt为50.6±17 L，男性为51.2±17 L，女性为49.7±16 L。V（沃森公式）为34.5±6 L。使用OCM的Kt和V测量的Kt/V为1.499±0.54，血液样本中测量的Kt/V为1.742±0.58。两者之间的相关性为0.956。Kt根据所使用的透析模式不同而有所差异：HD且Qd为500时为44.7±15 L，HD且Qd为800时为50.7±17 L，在线HDF（置换液量22.1±7 L）时为51.8±17 L。血液样本中的Kt/V也显示出差异：HD且QD为500时为1.60±0.55，HD且Qd为800时为1.726±0.56，在线HDF时为1.776±0.59。在本研究中观察到新的生物传感器OCM与血液样本测量值之间存在密切相关性。因此，该传感器在所有透析治疗模式中都有用，包括在线HDF。该传感器能够区分本研究中使用的不同透析模式的疗效。
