Maeda H, Takahashi S, Inoue M, Hatano M
2nd Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 1991 May;33(5):513-22.
Urea kinetic modeling (UKM) was carried out to evaluate the water control in patients undergoing long-term hemodialysis. In 21 patients on chronic dialysis, the results of two different determinations of the total body water, i.e. by the deuterium oxide (D2O) method and by UKM, were compared. A correlation was observed with Y = 0.98X + 5.9 (P less than 0.01, r = 0.91) for males and Y = 0.97X + 6.2 (P less than 0.01, r = 0.90) for females, indicating that UKM is useful for determining the total body water. In addition, the 21 patients were classified into two groups based on their ECG findings, and UKM was performed in the two groups for comparison. The values of the total body water were 68.5 +/- 4.0% and 68.6 +/- 6.2% of body weight, respectively, with no significant difference between them. However, the CTR was 50.2 +/- 2.8% and 46.2 +/- 4.4%, respectively. Thus, not only X-ray examinations but also UKM should be carried out to determine the standard weight (SW-DW) in the presence of cardiac dysfunction. Instructions for water control were given when the total body water exceeded 73% during the UKM measurements over 5 years, which allowed an optimal total body water to be maintained thereafter. The possible influence of erythropoietin (EPO) was also examined by performing UKM in 8 cases receiving EPO and 7 cases without EPO. No noticeable difference was observed between the two groups. 17 patients using a polyacrylonitrile (PAN) membrane were further divided into those with and those without EPO to evaluate the possible influence of the PAN membrane-EPO combination. As a result, no significant difference was demonstrated, suggesting that UKM can be satisfactorily performed under such conditions. In 11 patients on chronic dialysis, the levels of alpha-human atrial natriuretic peptide (alpha-hANP) were measured pre- and post-dialysis to examine the relationship between the change in alpha-hANP and rate of weight loss (%). A significant correlation was observed with Y = 12.8X + 5.1 (P less than 0.05, r = 0.68). In conclusion, UKM was found to be useful for evaluating the water control and for assessing the optimal dialysis in patients receiving long-term hemodialysis.
进行尿素动力学建模（UKM）以评估长期血液透析患者的水分控制情况。在21例慢性透析患者中，比较了两种不同方法测定总体水的结果，即氧化氘（D2O）法和UKM法。观察到男性的相关性为Y = 0.98X + 5.9（P小于0.01，r = 0.91），女性为Y = 0.97X + 6.2（P小于0.01，r = 0.90），这表明UKM可用于测定总体水。此外，根据心电图结果将21例患者分为两组，并对两组进行UKM比较。总体水的值分别为体重的68.5 +/- 4.0%和68.6 +/- 6.2%，两者之间无显著差异。然而，中心血容量分别为50.2 +/- 2.8%和46.2 +/- 4.4%。因此，在存在心脏功能障碍的情况下，不仅应进行X线检查，还应进行UKM以确定标准体重（SW-DW）。在5年的UKM测量期间，当总体水超过73%时给出了水分控制指导，此后可维持最佳总体水。还通过对8例接受促红细胞生成素（EPO）治疗的患者和7例未接受EPO治疗的患者进行UKM，研究了EPO的可能影响。两组之间未观察到明显差异。将17例使用聚丙烯腈（PAN）膜的患者进一步分为接受EPO和未接受EPO两组，以评估PAN膜-EPO组合的可能影响。结果显示无显著差异，表明在这种情况下UKM可以令人满意地进行。在11例慢性透析患者中，透析前和透析后测量了α-人心房利钠肽（α-hANP）水平，以研究α-hANP变化与体重减轻率（%）之间的关系。观察到显著相关性为Y = 12.8X + 5.1（P小于0.05，r = 0.68）。总之，发现UKM有助于评估长期血液透析患者的水分控制情况和评估最佳透析效果。
