Laboratory for Applied PK/PD, Division of Clinical Pharmacology and Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
ASAIO J. 2010 May-Jun;56(3):246-53. doi: 10.1097/MAT.0b013e3181cf07d2.
Incorporating urea rebound using equilibrated urea concentration (Ceq) after hemodialysis (HD) is essential for accurate assessment of HD efficiency. It is impractical to measure Ceq in clinical settings, and there are no recommended methodologies to predict Ceq in children. The objective of this work is to assess the ability of an Individualized Bayesian Urea Kinetic Model (IBKM) for predicting Ceq in children receiving HD. Developed based on adult HD data, the IBKM is a two-pool urea kinetic model that calculates Bayesian estimates of individual Ceq. Blood urea nitrogen (BUN) samples from 30 HD sessions in 13 children (age 12-18 years) were taken at pre-HD, immediately post-HD, and 60 minutes post-HD (Ceq). The IBKM and estimated population parameters from adult data were fitted to the observed data from children to predict individual Ceq using NONMEM VI software in comparison with observed Ceq (9.5 +/- 3.8 mmol/L), the average individual predicted Ceq was 9.4 +/- 3.8 mmol/L, with absolute individual prediction error of 6.2% +/- 4.4%. For a given dialysis goal and desired dialysis duration, the required blood flow rate and dialyzer size are predicted by IBKM and confirmed by the analysis data. This study suggests that the IBKM can be used in a pediatric HD setting and accurately predict Ceq in children using only pre-HD and immediately post-HD BUN.
在血液透析（HD）后使用平衡尿素浓度（Ceq）纳入尿素反弹对于准确评估 HD 效率至关重要。在临床环境中测量 Ceq 是不切实际的，也没有推荐的方法来预测儿童的 Ceq。这项工作的目的是评估个体化贝叶斯尿素动力学模型（IBKM）在预测接受 HD 的儿童 Ceq 方面的能力。IBKM 基于成人 HD 数据开发，是一种双池尿素动力学模型，可计算个体 Ceq 的贝叶斯估计值。从 13 名儿童（年龄 12-18 岁）的 30 次 HD 治疗中采集了 HD 前、HD 后即刻和 HD 后 60 分钟的血尿素氮（BUN）样本（Ceq）。使用 NONMEM VI 软件将 IBKM 和成人数据中的估计群体参数拟合到儿童的观察数据中，以预测个体 Ceq，并与观察到的 Ceq（9.5 +/- 3.8 mmol/L）进行比较，平均个体预测 Ceq 为 9.4 +/- 3.8 mmol/L，个体预测误差绝对值为 6.2% +/- 4.4%。对于给定的透析目标和所需的透析持续时间，IBKM 预测所需的血流量和透析器尺寸，并通过分析数据确认。这项研究表明，IBKM 可用于儿科 HD 环境，并仅使用 HD 前和 HD 后即刻的 BUN 准确预测儿童的 Ceq。
