Spalding Elaine M, Chandna Shahid M, Davenport Andrew, Farrington Ken
Renal Unit, Lister Hospital, Coreys Mill Lane, Stevenage, Herts, UK.
Kidney Int. 2008 Aug;74(3):348-55. doi: 10.1038/ki.2008.185. Epub 2008 May 28.
Current guidelines suggest a minimum Kt/V of 1.2 for three weekly hemodialysis sessions; however, using V as a normalizing factor has been questioned. Parameters such as weight(0.67) (W(0.67)) and body surface area (BSA) that reflect the metabolic rate may be preferable. To determine this, we studied 328 hemodialysis patients (221 male) with a target Kt/V of 1.2. Using this relationship and the individual's Watson Volume, we calculated the Kt, Kt/BSA, and Kt/W(0.67) equivalent to the target and measured the effects of body size and gender on these parameters for each patient. The target corresponded to a range of equivalent Kt/BSA and Kt/W(0.67) each significantly higher in males than females and in larger than smaller males. V/BSA and V/W(0.67), the conversion factors of Kt/V to Kt/BSA and Kt/W(0.67) respectively, were significantly greater in males than females and heavier than lighter men. Our study shows that if Kt/BSA and Kt/W(0.67) reflect the true required dose, prescribing a target Kt/V of 1.2 would underestimate this in females and in small males. Further work is required to develop clinical outcome-based adequacy targets.
当前指南建议，每周进行三次血液透析时，最低Kt/V值应为1.2；然而，将V用作标准化因子受到了质疑。反映代谢率的参数，如体重(0.67)（W(0.67)）和体表面积（BSA）可能更可取。为了确定这一点，我们研究了328名血液透析患者（221名男性），目标Kt/V为1.2。利用这种关系和个体的沃森体积，我们计算了相当于目标值的Kt、Kt/BSA和Kt/W(0.67)，并测量了体型和性别对每位患者这些参数的影响。该目标对应于一系列等效的Kt/BSA和Kt/W(0.67)，男性的数值均显著高于女性，体型较大的男性高于体型较小的男性。Kt/V分别转换为Kt/BSA和Kt/W(0.67)的转换因子V/BSA和V/W(0.67)，男性显著高于女性，体重较重的男性高于体重较轻的男性。我们的研究表明，如果Kt/BSA和Kt/W(0.67)反映了真正所需的剂量，规定目标Kt/V为1.2会低估女性和体型较小男性的剂量。需要进一步开展工作，以制定基于临床结果的充分性目标。
