Torregrosa E, Hernández-Jaras J, García-Pérez H, Pons-Prades R, Calvo-Gordo C, Ríus-Peris A, Sánchez-Canel J J, Pin-Godos M
Servicio de Nefrología, Hospital General de Castellón.
Nefrologia. 2006;26(2):246-52.
The "gold standard" method to measure the mass balance achieved during dialysis for a given solute is based on the total dialysate collection. This procedure is unfeasible and too cumbersome. For this reason, alternative methods have been proposed including the urea kinetic modelling (Kt/V), the measurement of effective ionic dialysance (Diascan), and the continuous spent sampling of dialysate (Quantiscan). The aim of this study was to compare the reliability and agreement of these two methods with the formulas proposed by the urea kinetic modelling for measuring the dialysis dose and others haemodialysis parameters. We studied 20 stable patients (16 men/4 women) dialyzed with a monitor equipped with the modules Diascan (DC) and Quantiscan (QC) (Integra. Hospal). The urea distribution volume (VD) was determined using anthropometric data (Watson equation) and QC data. Kt/V value was calculated according to Daurgidas 2nd generation formula corrected for the rebound (eKt/V), and using DC (Kt/VDC) and QC (Kt/VQC) data. The total mass of urea removed was calculated as 37,93 +/- 16 g/session. The VD calculated using Watson equation was 35.7 +/- 6.6 and the VDQC was 35.06 +/- 9.9. And they showed an significative correlation (r:0,82 p < 0.001). The (VDQC-VDWatson) difference was -0.64 +/- 5.8L (ns). Kt/VDC was equivalent to those of eKt/V (1.64 +/- 0.33 and 1.61 +/- 0.26, mean difference -0.02 +/- 0.29). However, Kt/VQC value was higher than eKt/V (1.67 +/- 0.22 and 1.61 +/- 0.26 mean difference 0.06 +/- 0.07 p < 0.01). Both values correlated highly (R2: 0.92 p < 0.001). Urea generation (C) calculated using UCM was 8.75 +/- 3.4 g/24 h and those calculated using QC was 8.64 +/- 3.21 g/24 h. Mean difference 0.10 +/- 1.14 (ns). G calculated by UCM correlated highly with that derived from QC (R2: 0.88 p < 0.001). In conclusion, Kt/VDC and Kt/VQC should be considered as valid measures for dialysis efficiency. However, the limits of agreement between Kt/VQC and eKt/V were closer than Kt/VDC.
测量给定溶质在透析过程中质量平衡的“金标准”方法基于收集全部透析液。此过程不可行且过于繁琐。因此，已提出了替代方法，包括尿素动力学建模（Kt/V）、有效离子透析率测量（Diascan）以及透析液连续取样（Quantiscan）。本研究的目的是比较这两种方法与尿素动力学建模提出的用于测量透析剂量及其他血液透析参数的公式的可靠性和一致性。我们研究了20例稳定的患者（16名男性/4名女性），他们使用配备了Diascan（DC）和Quantiscan（QC）模块（Integra. Hospal）的监测仪进行透析。使用人体测量数据（沃森方程）和QC数据确定尿素分布容积（VD）。根据经反弹校正的第二代Daurgidas公式（eKt/V），并使用DC（Kt/VDC）和QC（Kt/VQC）数据计算Kt/V值。每次透析清除的尿素总质量计算为37.93±16克。使用沃森方程计算的VD为35.7±6.6，VDQC为35.06±9.9。它们显示出显著相关性（r：0.82，p<0.001）。（VDQC - VDWatson）差值为 -0.64±5.8升（无显著性差异）。Kt/VDC与eKt/V相当（分别为1.64±0.33和1.61±0.26，平均差值 -0.02±0.29）。然而，Kt/VQC值高于eKt/V（分别为1.67±0.22和1.61±0.26，平均差值0.06±0.07，p<0.01）。两个值高度相关（R2：0.92，p<0.001）。使用UCM计算的尿素生成率（C）为8.75±3.4克/24小时，使用QC计算的为8.64±3.21克/24小时。平均差值0.10±1.14（无显著性差异）。由UCM计算的G与由QC得出的G高度相关（R2：0.88，p<0.001）。总之，Kt/VDC和Kt/VQC应被视为透析效率的有效测量方法。然而，Kt/VQC与eKt/V之间的一致性界限比Kt/VDC更窄。
