Lowrie E G, Li Z, Ofsthun N J, Lazarus J M
Fresenius Medical Care North America, Lexington, Massachusetts, USA.
Kidney Int. 2006 Jul;70(1):211-7. doi: 10.1038/sj.ki.5001507. Epub 2006 May 24.
New technology now supports direct online measurements of total dialysis dose per treatment, Kt. An outcome-based, nonlinear method for estimating target Kt in terms of ionic clearance measurements and body surface area (BSA) has been described recently. This is a validation study of the new method that evaluates the relationship between the (actual Kt-target Kt) difference and death risk. Patients with Kt measurements during March 2004 were identified (N=59,644). Target Kt was determined for each patient using the new method. Patients were then grouped by (actual Kt-target Kt) decile. They were also grouped by (actual URR-target URR) decile. Cox analysis-based risk profiles were constructed using those groupings. The (actual Kt-target Kt) difference profiles suggested improving death risk as Kt increased from below target to equal target. Risk ratios then flattened and remained so until (actual Kt-target Kt) reached the highest decile at which it appeared to improve, suggesting a possible biphasic profile. The (URR-target URR) risk profile was U-shaped. Death risk was related to the difference between the actual Kt and a target Kt value selected using the new nonlinear method. The method is therefore valid for prescribing and monitoring hemodialysis treatment.
新技术现在支持对每次治疗的总透析剂量Kt进行直接在线测量。最近描述了一种基于结果的非线性方法，用于根据离子清除率测量和体表面积（BSA）估算目标Kt。这是一项对新方法的验证研究，评估了（实际Kt-目标Kt）差值与死亡风险之间的关系。确定了2004年3月期间进行Kt测量的患者（N = 59,644）。使用新方法为每位患者确定目标Kt。然后根据（实际Kt-目标Kt）十分位数对患者进行分组。他们还根据（实际URR-目标URR）十分位数进行分组。使用这些分组构建基于Cox分析的风险概况。（实际Kt-目标Kt）差值概况表明，随着Kt从低于目标值增加到等于目标值，死亡风险有所改善。然后风险比率趋于平稳并保持不变，直到（实际Kt-目标Kt）达到最高十分位数，此时似乎有所改善，表明可能存在双相概况。（URR-目标URR）风险概况呈U形。死亡风险与实际Kt和使用新非线性方法选择的目标Kt值之间的差值有关。因此，该方法对于规定和监测血液透析治疗是有效的。
