Kjellstrand Carl M, Ing Todd S, Kjellstrand Per T, Odar-Cederlof Ingegerd, Lagg Chris R B
Hines VA/Loyola University Chicago, Chicago, Illinois, USA.
Hemodial Int. 2011 Apr;15(2):226-33. doi: 10.1111/j.1542-4758.2011.00538.x. Epub 2011 Feb 25.
We studied phosphorus (P) dynamics and its relation to urea dynamics in a wide range of dialyses by measuring predialysis and postdialysis serum P levels and all removed P and urea in dialysate during 455 hemodialyses. Dialyses were performed at different frequencies (range 3-6 treatments/wk); duration of dialysis (t) (range 80-560 minutes), varied blood and dialysate flow, and with high-flux and low-flux membranes. Kt/V-P, Kt/V-urea, weekly removal of P-and urea and removal volumes (Vr) and their relationships to varying dialyses, and predialysis concentrations, and protein catabolic rates were studied in linear and multiple regression analyses. A weekly dialysis time of > 30 hours was needed to maintain serum P concentration normal without the use of phosphate binders. Vr-P as a percentage of body weight was dependent on predialysis serum P and increased steeply as predialysis serum P decreased and dialysis time was prolonged. There was no relationship between Vr-urea and Vr-P. Phosphorus removal per week was mainly dependent on weekly frequency, and time on dialysis and > 38 h/wk were necessary to remove the recommended P intake. Phosphorus shows highly variable dynamics during dialysis. The body maintains extracellular P concentration by releasing P from large compartments when the dialysis time is prolonged and the serum concentration of P decreases during dialysis. Vr-P shows huge variation between patients and in an individual patient, depending on predialysis serum P. Kt/V is inaccurate in describing P removal. To remove P efficiently, it is most important to perform long and more frequent hemodialysis.
我们通过测量455次血液透析过程中的透析前和透析后血清磷水平以及透析液中所有清除的磷和尿素，研究了广泛范围内透析中磷（P）的动态变化及其与尿素动态变化的关系。透析以不同频率（每周3 - 6次治疗）进行；透析时间（t）（80 - 560分钟）、血液和透析液流量各不相同，并使用了高通量和低通量膜。在直线回归和多元回归分析中研究了Kt/V-P、Kt/V-尿素、每周磷和尿素的清除量、清除体积（Vr）及其与不同透析、透析前浓度和蛋白质分解代谢率的关系。在不使用磷结合剂的情况下，每周透析时间> 30小时才能维持血清磷浓度正常。Vr-P占体重的百分比取决于透析前血清磷，并且随着透析前血清磷降低和透析时间延长而急剧增加。Vr-尿素与Vr-P之间没有关系。每周的磷清除主要取决于每周的透析频率，且每周需要> 38小时的透析时间才能清除推荐的磷摄入量。磷在透析过程中表现出高度可变的动态变化。当透析时间延长且透析过程中血清磷浓度降低时，身体通过从大的储存库中释放磷来维持细胞外磷浓度。Vr-P在患者之间以及个体患者中差异巨大，这取决于透析前血清磷。Kt/V在描述磷清除方面不准确。为了有效清除磷，进行长时间且更频繁的血液透析最为重要。
