Manotham Krissanapong, Tiranathanagul Khajohn, Praditpornsilpa Kearkiat, Eiam-Ong Somchai
Nephrology unit, Medicine, Leardsin General Hospital.
J Med Assoc Thai. 2006 Aug;89 Suppl 2:S79-85.
The targets of dialysis per session, in terms of Kt/V and URR are well established for thrice-a-week hemodialysis (HD). The target values of these parameters could not be applied for the patients undergoing twice-a-week HD, which is performed in several developing countries. The equivalent renal urea clearance EKR (EKR [mL/min) = G (mg/min)/TAC (mg/mL)], which measures urea clearance in a continuous fashion, has been used in comparing amount of dialysis among the different modalities. For any chronic dialysis regimens the target EKRc, which was normalized to urea volume of distribution of 40 L, would be above 13 mL/min. Therefore, there is no data available regarding Kt/V, URR, and EKRc for twice-a-week HD.
The EKRc of 26 Thai patients treated with twice-a-week high flux HD were measured monthly for 12 months. The Kt/V, URR, and serum albumin were also measured monthly.
Overall, the mean EKRc of 294 patient-month analysis was 11.68 +/- 0.16 mL/min. Monthly EKRc had a high correlation to Kt/V (r = 0.80) and URR (r = 0.82). When serum albumin was employed as a surrogate marker for treatment failure, ROC analysis revealed that EKRc above 13 mL/min had 90% and 100% probabilities to maintain monthly and 12-month serum albumin levels above 4 gm/dL, respectively. To obtain the target EKRc above 13 mL/min at 90 and 95% confidence, the values of Kt/V per session were 2.11 and 2.25, respectively while those of URR were 82.89 and 84.52%, respectively.
For twice-a-week HD, to have the EKRc level above 13 mL/min, at 95% confidence, the Kt/V should exceed 2.2 and the URR should exceed 85% per session.
对于每周三次的血液透析（HD），每次透析的Kt/V和尿素清除率（URR）目标已明确确立。这些参数的目标值不适用于一些发展中国家进行的每周两次HD的患者。等效肾脏尿素清除率EKR（EKR[毫升/分钟]=G[毫克/分钟]/TAC[毫克/毫升]）以连续方式测量尿素清除率，已用于比较不同透析方式的透析量。对于任何慢性透析方案，归一化为尿素分布容积40升的目标EKRc应高于13毫升/分钟。因此，尚无关于每周两次HD的Kt/V、URR和EKRc的数据。
对26例接受每周两次高通量HD治疗的泰国患者，每月测量其EKRc，持续12个月。每月还测量Kt/V、URR和血清白蛋白。
总体而言，294例患者月分析的平均EKRc为11.68±0.16毫升/分钟。每月EKRc与Kt/V（r=0.80）和URR（r=0.82）高度相关。当将血清白蛋白用作治疗失败的替代标志物时，ROC分析显示，EKRc高于13毫升/分钟时，分别有90%和100%的概率使每月和12个月的血清白蛋白水平维持在4克/分升以上。为在90%和95%置信度下获得高于13毫升/分钟的目标EKRc，每次透析的Kt/V值分别为2.11和2.25，而URR值分别为82.89%和84.52%。
对于每周两次的HD，为使EKRc水平在95%置信度下高于13毫升/分钟，每次透析的Kt/V应超过2.2，URR应超过85%。
