Maduell Francisco, Vera Manel, Arias Marta, Serra Nuria, Blasco Miguel, Bergadá Eduardo, Fontsere Nestor, Cases Aleix, Campistol Josep M
Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain.
Am J Kidney Dis. 2008 Jul;52(1):85-92. doi: 10.1053/j.ajkd.2008.03.014. Epub 2008 May 2.
Ionic dialysance can provide accurate monitoring of dialysis dose during each hemodialysis session. Increasingly, hemodialysis machines incorporate devices that measure ionic dialysance, allowing the dialysis dose to be determined noninvasively in real time and in each session. Because Kt product was proposed as a measure of hemodialysis dose to avoid the reverse J-shaped curve between urea reduction ratio or Kt/V and mortality, we investigated whether ionic dialysance values and Kt measurements are affected by different ionic dialysance monitors (Diascan and online clearance monitoring [OCM]) and dialysis machines.
Four-period crossover.
SETTING & PARTICIPANTS: 31 adult long-term hemodialysis patients using 2 different ionic dialysance monitors in 4 dialysis machines: Diascan in Hospal Integra and Gambro AK-200 machines and OCM in Fresenius 4008S and 5008 machines.
Ionic dialysance monitor and machine used in 4 hemodialysis sessions for each participant.
Kt and Kt/V measured by using ionic dialysance and serum urea nitrogen.
Mean values for initial and final ionic dialysance were similar for Integra and AK-200 machines, both measured by using Diascan, and for the 4008S and 5008 machines, both measured by using OCM; however, OCM values tended to be greater in the 4008S and 5008 machines. Kt measured in the 4008S and 5008 machines was greater (59.6 +/- 12 and 58.6 +/- 11 L, respectively) than with the Integra and AK-200 machines (53.4 +/- 11 and 53.8 +/- 11 L). Mean urea reduction ratio and Kt/V were 78.0% +/- 8% and 1.89 +/- 0.43 for Diascan monitors and 79.6% +/- 8% and 1.99 +/- 0.44 for OCM monitors, respectively (P < 0.01). Differences between monitors in Kt determination were caused in part by a real difference in dialysis effectiveness (6%) and in part by an intermethod difference (4%). Kt adjusted by Kt/V differences was recalculated, and because of good correlation between Diascan and OCM, we were able to apply a formula (Kt(OCM) = 1.08 Kt(Diascan) - 2; r =0.95) that allowed both Kt quantification methods to be compared.
Nonblinded nonrandomized small sample.
Kt is a valid method for judging dialysis dose in real time by using ionic dialysance measurements. Adjustments to correct intermethod differences may be necessary to ensure generalizability among ionic dialysance monitors.
离子透析率可在每次血液透析过程中提供对透析剂量的准确监测。越来越多的血液透析机配备了测量离子透析率的装置，使得能够在每次透析过程中实时、无创地确定透析剂量。由于提出用Kt乘积作为血液透析剂量的衡量指标以避免尿素清除率或Kt/V与死亡率之间的反J形曲线，我们研究了不同的离子透析率监测仪（Diascan和在线清除率监测[OCM]）以及透析机是否会影响离子透析率值和Kt测量。
四期交叉试验。
31例成年长期血液透析患者，在4台透析机上使用2种不同的离子透析率监测仪：在百特Integra和金宝AK - 200机器上使用Diascan，在费森尤斯4008S和5008机器上使用OCM。
每位参与者在4次血液透析过程中使用的离子透析率监测仪和机器。
使用Diascan测量的Integra和AK - 200机器的初始和最终离子透析率平均值相似，使用OCM测量的4008S和5008机器的初始和最终离子透析率平均值也相似；然而，4008S和5008机器的OCM值往往更高。在4008S和5008机器上测量的Kt更大（分别为59.6±12和58.6±11L），高于Integra和AK - 200机器（53.4±11和53.8±11L）。Diascan监测仪的平均尿素清除率和Kt/V分别为78.0%±8%和1.89±0.43，OCM监测仪的平均尿素清除率和Kt/V分别为79.6%±8%和1.99±0.44（P<0.01）。监测仪之间Kt测定的差异部分是由于透析效果的实际差异（6%），部分是由于方法间差异（4%）。重新计算了根据Kt/V差异调整后的Kt，由于Diascan和OCM之间具有良好的相关性，我们能够应用一个公式（Kt(OCM)=1.08Kt(Diascan)-2；r = 0.95），该公式可对两种Kt定量方法进行比较。
非盲法、非随机、小样本。
Kt是通过离子透析率测量实时判断透析剂量的有效方法。可能需要进行调整以纠正方法间差异，以确保在离子透析率监测仪之间具有通用性。
