Yanai M, Man N K, Lebkiri B, Boudier L, Takahashi S
Département de Néphrologie, Hôpital Necker, Centre d'Hémodialyse de l'Alma.
Nihon Jinzo Gakkai Shi. 1991 Sep;33(9):907-13.
In an attempt to evaluate the adequacy of regular dialysis therapy, calculations of Kt/V-urea and protein catabolic rate (pcr) from the data of routine laboratory examinations by means of urea kinetic modeling were performed in 59 regular dialysis patients (28 males and 31 females; mean age, 59 +/- 2 years old; mean dialysis duration, 83 +/- 10 months). The mean values of Kt/V-urea and pcr were 1.10 +/- 0.04 and 0.98 +/- 0.03 g/kgBW.day, respectively. The number of patients who were within the optimal range (0.9-1.4 for Kt/V urea and 0.9-1.5 for pcr) was 37 (62.7%) for Kt/V-urea and 38 (64.4%) for pcr. Furthermore, we inferred that, based on an appropriate dietary protein intake, removal of urea by intermittent dialysis should be adjusted to maintain the patient in equilibrium for a defined pre-dialysis plasma urea concentration. From the data obtained, we concluded that: (1) it is possible to apply urea kinetic modeling on the basis of routine laboratory examinations, (2) it is important to maintain the pre-dialysis plasma urea concentration at more than a certain level, and (3) it is also important to control the post-dialysis plasma urea concentration at a low level.
为评估常规透析治疗的充分性，我们对59例常规透析患者（28例男性和31例女性；平均年龄59±2岁；平均透析时间83±10个月），根据常规实验室检查数据，采用尿素动力学模型计算了Kt/V-尿素和蛋白质分解代谢率（pcr）。Kt/V-尿素和pcr的平均值分别为1.10±0.04和0.98±0.03g/kg体重·天。Kt/V-尿素处于最佳范围（Kt/V尿素为0.9 - 1.4，pcr为0.9 - 1.5）的患者人数，Kt/V-尿素为37例（62.7%），pcr为38例（64.4%）。此外，我们推断，基于适当的饮食蛋白质摄入量，应调整间歇性透析对尿素的清除，以使患者在透析前血浆尿素浓度达到特定水平时保持平衡。根据所获得的数据，我们得出以下结论：（1）基于常规实验室检查应用尿素动力学模型是可行的；（2）将透析前血浆尿素浓度维持在一定水平以上很重要；（3）将透析后血浆尿素浓度控制在较低水平也很重要。
