LeFebvre J M, Spanner E, Heidenheim A P, Lindsay R M
Department of Medicine, Victoria Hospital, London, Ontario, Canada.
ASAIO Trans. 1991 Jul-Sep;37(3):M132-3.
Monthly urea kinetic modeling is performed [service Kt/V (urea)] to ensure that dialysis prescriptions provide patients a Kt/V greater than or equal to 1 and yield a protein catabolic rate (PCR) greater than or equal to 0.8. The frequency with which the dialysis prescription (physician's order +/- 5%, p +/- 5%) was achieved was calculated by three methods: 1) CompuMod (3 ureas; computer derived), 2) Jindal-Goldstein, and 3) Daugirdas, (2 and 3% reduction of urea). Ten patients were followed serially over 1 month for a total of 120 dialyses. Mean Kt/V values for each method were: prescription, 1.54 +/- 0.36; service, 1.40 +/- t0.63; CompuMod, 1.33 +/- 0.27; Jindal-Goldstein, 1.55 +/- 0.24; and Daugirdas, 1.33 +/- 0.23. The percentages of dialyses within the p +/- 5% were 12.4%, CompuMod; 12.8%, Jindal-Goldstein and 14.3%, Daugirdas. The percentages above p +/- 5% were 20.4%, CompuMod; 47%, Jindal-Goldstein; and 21.4%, Daugirdas. The percentages below p +/- 5% were 67.3%, CompuMod; 40.2%, Jindal-Goldstein; and 64.3%, Daugirdas. The CompuMod and Daugirdas methods of assessment of Kt/V were significantly lower (p less than 0.001) than the prescribed Kt/V, whereas the Jindal-Goldstein estimate was not. The authors conclude that dialysis patients rarely achieve their prescribed Kt/V. The service Kt/V, therefore, is not a useful parameter for prescribing dialysis therapy. The CompuMod and Daugirdas methods are the best estimates of the Kt/V, while the Jindal-Goldstein equation overestimates the Kt/V. The need for frequent urea kinetic modelling is stressed. An online urea monitor for each dialysis would be the ideal solution.
每月进行尿素动力学建模（服务Kt/V（尿素）），以确保透析处方为患者提供的Kt/V大于或等于1，并产生大于或等于0.8的蛋白质分解代谢率（PCR）。通过三种方法计算达到透析处方（医生医嘱±5%，p±5%）的频率：1）CompuMod（3次尿素测定；计算机推导），2）Jindal - Goldstein法，3）Daugirdas法（尿素减少2%和3%）。对10名患者进行了为期1个月的连续跟踪，共进行了120次透析。每种方法的平均Kt/V值分别为：处方，1.54±0.36；服务，1.40±0.63；CompuMod，1.33±0.27；Jindal - Goldstein，1.55±0.24；Daugirdas，1.33±0.23。在p±5%范围内的透析百分比分别为：CompuMod法12.4%；Jindal - Goldstein法12.8%；Daugirdas法14.3%。高于p±5%的百分比分别为：CompuMod法20.4%；Jindal - Goldstein法47%；Daugirdas法21.4%。低于p±5%的百分比分别为：CompuMod法67.3%；Jindal - Goldstein法40.2%；Daugirdas法64.3%。CompuMod法和Daugirdas法评估的Kt/V显著低于规定的Kt/V（p＜0.001），而Jindal - Goldstein法的估计值则不然。作者得出结论，透析患者很少能达到规定的Kt/V。因此，服务Kt/V不是用于规定透析治疗的有用参数。CompuMod法和Daugirdas法是对Kt/V的最佳估计，而Jindal - Goldstein方程高估了Kt/V。强调了频繁进行尿素动力学建模的必要性。每次透析配备在线尿素监测仪将是理想的解决方案。
