Pedrini L A, Ponti R, Faranna P, Cozzi G, Locatelli F
Servizio di Nefrologia e Dialisi, Ospedale, S. Isidoro, Bergamo, Italy.
Kidney Int. 1991 Sep;40(3):525-32. doi: 10.1038/ki.1991.241.
A computer model was developed to simulate sodium and water kinetics during hemodiafiltration (HDF), acetate-free biofiltration (AFB) and hemodialysis (HD). Multiple regression analysis of the results of 3,240 simulated applications of the model (1,620 HDF, 1,080 AFB, 540 HD) showed that, during HDF and AFB, there is a close correlation (R2 = 0.92 and 0.91) between plasma water sodium concentration [( Na+P]) and a set of three variables: 1) the sodium gradient between plasma water and dialysate, 2) the sodium concentration of the substitution fluid and 3) ultrafiltration (UF) rate. With HD, a close correlation (R2 = 0.94) was found between changes in [Na+P] and combined changes in sodium gradient and the UF rate. On this basis, a regression equation was formulated for each procedure which allowed a reliable prediction of final [Na+P] to be made on the basis of knowledge of the imposed Na gradient, the programmed infusion (during HDF and AFB), and the UF rate. Clinical validation of the model was obtained in 12 patients: predicted final [Na+P] agreed well with the values measured by means of direct potentiometry (141.9 vs. 142.1 mEq/liter; P = NS), with a mean difference (-0.16 mEq/liter) and limits of agreement (+0.8 to -1.03 mEq/liter) fully acceptable for clinical purposes.(ABSTRACT TRUNCATED AT 250 WORDS)
开发了一种计算机模型，用于模拟血液透析滤过（HDF）、无醋酸盐生物滤过（AFB）和血液透析（HD）过程中的钠和水动力学。对该模型3240次模拟应用结果（1620次HDF、1080次AFB、540次HD）进行多元回归分析表明，在HDF和AFB过程中，血浆水钠浓度[（Na⁺P）]与一组三个变量之间存在密切相关性（R² = 0.92和0.91）：1）血浆水与透析液之间的钠梯度；2）置换液的钠浓度；3）超滤（UF）率。对于HD，发现[Na⁺P]的变化与钠梯度和UF率的综合变化之间存在密切相关性（R² = 0.94）。在此基础上，为每个程序制定了回归方程，基于施加的钠梯度、程序化输注（在HDF和AFB期间）和UF率的知识，可以可靠地预测最终的[Na⁺P]。在12名患者中对该模型进行了临床验证：预测的最终[Na⁺P]与通过直接电位法测量的值非常吻合（141.9对142.1 mEq/升；P = 无显著性差异），平均差异为（-0.16 mEq/升），一致性界限为（+0.8至-1.03 mEq/升），对于临床目的而言完全可以接受。（摘要截断于250字）
