Molina Núñez M, Roca Meroño S, de Alarcón Jiménez R M, García Hernández M A, Jimeno Griño C, Alvarez Fernández G M, Navarro Parreño M J, Pérez Silva F M
Servicio de Nefrología, Hospital Universitario Santa María del Rosell, Cartagena, Murcia.
Nefrologia. 2010;30(3):331-6. doi: 10.3265/Nefrologia.pre2010.Apr.10408.
The haemodialysis dose is a good marker of dialysis adequacy, and we usually monitor it with Kt/V measure. The dialysis dose monitored with Kt allows a better discrimination, detecting a percentage of the patients that perhaps do not get an adequate dose for their gender or body surface area after treatment with a minimum recommended dose of Kt/V. The objective of this study was to evaluate Kt as a clinical indicator referred to dialysis adequacy in the haemodialysis population. The aim was that more than 85% of the patients would achieve the recommended Kt target for their gender (at least 50 litres in men and 45 litres in women), or their body surface area. In each of the patients (mean 129) the Kt mean value was determined for three consecutive dialysis sessions, one every two months, during the follow-up period (14 months). At the beginning, the Kt/V value was on target (> 1.3) in 93.2% of the patients, but only in 58% according to Kt measure for their gender. After 4 months, we observed that 85% of patients' Kt target increased for their gender, but only 68% did if we used the Kt individualised for their body surface area. From month 6 to the end of the follow-up period, more than 85% of patients obtained an adequate Kt for their body surface area (p < 0.001). A significant increase of Kt mean (5.4 litres) was observed at the end of the study (p < 0.001). The usual dialysis prescription parameters were modified increasing blood flow rate (34.14 ml/min, p < 0.001), session effective duration (8.04 minutes, p < 0.001), dialyser surface area (24.1% of patients changed from helixone 1.3 to 1.6 m2, p < 0.001) and haemodialysis modality (56.8% of patients changed from conventional haemodialysis to on-line haemodiafiltration, p < 0.001). We conclude that monitoring dialysis dose with Kt is a good clinical measure of adequacy, and using it as a quality indicator can be done in line with the more demanding quality standards.
血液透析剂量是透析充分性的一个良好指标，我们通常用Kt/V测量值来监测它。用Kt监测透析剂量能实现更好的区分，可检测出在接受最低推荐剂量的Kt/V治疗后，可能因性别或体表面积而未获得足够剂量的患者比例。本研究的目的是评估Kt作为血液透析人群中透析充分性的一项临床指标。目标是超过85%的患者达到根据其性别（男性至少50升，女性至少45升）或体表面积推荐的Kt目标。在随访期（14个月）内，对每位患者（平均129例）连续三个透析疗程（每两个月一次）测定Kt平均值。开始时，93.2%的患者Kt/V值达标（>1.3），但根据性别Kt测量值，只有58%的患者达标。4个月后，我们观察到85%的患者根据性别Kt目标有所增加，但如果使用根据体表面积个体化的Kt，只有68%的患者达标。从第6个月到随访期结束，超过85%的患者根据体表面积获得了足够的Kt（p<0.001）。研究结束时观察到Kt平均值显著增加（5.4升）（p<0.001）。修改了通常的透析处方参数，增加了血流量（34.14毫升/分钟，p<0.001）、疗程有效时长（8.04分钟，p<0.001）、透析器表面积（24.1%的患者从1.3平方米的螺旋型透析器更换为1.6平方米的，p<0.001）以及血液透析方式（56.8%的患者从传统血液透析改为在线血液透析滤过，p<0.001）。我们得出结论，用Kt监测透析剂量是评估充分性的一项良好临床措施，将其用作质量指标可符合更严格的质量标准。
