Prince Salman Center for Kidney Disease, Riyadh, Kingdom of Saudi Arabia.
Ren Fail. 2010 Jan;32(1):36-40. doi: 10.3109/08860220903367486.
Adequate delivered dose of solute removal (as assessed by urea reduction and calculation of Kt/V) is an important determinant of clinical outcome in chronic hemodialysis (HD) patients. This requires both prescription of an adequate dose of HD and regular assessment that the delivered treatments are also adequate. Online conductivity monitoring (OCM) using sodium flux as a surrogate for urea allows for the repeated non-invasive measurement of Kt/V on each HD treatment.
We prospectively studied 17 (9 males, 8 females) established chronic HD patients over an eight-week period (408 treatments). A pre- and post-dialyzer measurement of the conductivity is performed by two mutually independent temperature-compensated conductivity cells equipped with Fresenius 4008 S(R) dialysis machines. Urea reduction was measured once a week by a single-pool calculation using immediate post-treatment sampling. No changes were made to any of the dialysis prescriptions over the study period. Values of calculated Kt/V and simultaneously obtained online Kt/V were compared.
There was a statistically significant difference between calculated Kt/V and online Kt/V over the study period. The mean calculated Kt/V was 1.37 +/- 0.09, and mean online Kt/V 1.02 +/- 0.15 (p = 0.000). Calculated Kt/V >or= 1.2 was achieved in all our patients, while online Kt/V >or= 1.2 was achieved in only 17.64%. Yet there was moderate correlation between calculated Kt/V and online Kt/V (r(2) = 0.48).
Online conductivity monitoring (OCM) results underestimates dialysis efficiency compared to calculated Kt/V readings. This difference has to be considered when applying Kt/V to clinical practice.
在慢性血液透析（HD）患者中，溶质清除的充分剂量（通过尿素减少和 Kt/V 的计算来评估）是临床结果的重要决定因素。这需要处方足够剂量的 HD，并定期评估所提供的治疗是否也足够。使用钠通量作为尿素的替代物的在线电导率监测（OCM）允许在每次 HD 治疗时重复进行非侵入性的 Kt/V 测量。
我们前瞻性地研究了 17 名（9 名男性，8 名女性）已建立的慢性 HD 患者，研究时间为 8 周（408 次治疗）。在透析器前后使用两个相互独立的温度补偿电导率细胞进行电导率的预透析和后透析测量，这些细胞配备了 Fresenius 4008 S(R)透析机。每周通过单次池计算使用即时治疗后采样测量尿素减少。在研究期间，对任何透析处方均未进行更改。比较了计算的 Kt/V 和同时获得的在线 Kt/V 值。
在研究期间，计算的 Kt/V 和在线 Kt/V 之间存在统计学上的显著差异。平均计算的 Kt/V 为 1.37 +/- 0.09，平均在线 Kt/V 为 1.02 +/- 0.15（p = 0.000）。我们所有的患者均达到了计算的 Kt/V >or= 1.2，而仅 17.64%的患者达到了在线 Kt/V >or= 1.2。然而，计算的 Kt/V 和在线 Kt/V 之间存在中度相关性（r(2) = 0.48）。
与计算的 Kt/V 读数相比，在线电导率监测（OCM）结果低估了透析效率。在将 Kt/V 应用于临床实践时，必须考虑到这种差异。
