Wang Mengjing, Li Haiming, Liao Huimin, Yu Yongfu, You Li, Zhu Jianguo, Huang Bihong, Yuan Li, Hao Chuanming, Chen Jing
Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Hemodial Int. 2012 Jul;16(3):363-76. doi: 10.1111/j.1542-4758.2012.00678.x. Epub 2012 Feb 23.
Precise assessing phosphate removal by hemodialysis (HD) is important to improve phosphate control in patients on maintenance HD. We reported a simple noninvasive model to estimate phosphate removal within a 4-hour HD. One hundred sixty-five patients who underwent HD 4 hours per session using low-flux dialyzers made of polysulfone (1.2 m(2)) or triacetate (1.3 m(2)) were enrolled. Blood flows varied from 180 to 300 mL/min. Effluent dialysate samples were collected during the 4-hour HD treatment to measure the total phosphate removal. Predialysis levels of serum phosphate, potassium, hematocrit, intact parathyroid hormone, total carbon dioxide (TCO(2)), alkaline phosphatase, clinical and dialysis characteristics were obtained. One hundred thirty-five observations were randomly selected for model building and the remaining 30 for model validation. Total amount of phosphate removal within the 4-hour HD was mostly 15-30 mmol. A primary model (model 1) predicting total phosphate removal was Tpo(4) = 79.6 × C(45) (mmol/L) - 0.023 × age (years) + 0.065 × weight (kg) - 0.12 × TCO(2) (mmol/L) + 0.05 × clearance (mL/min) - 3.44, where C(45) was phosphate concentration in spent dialysate measured at the 45 minute of HD and clearance was phosphate clearance of dialyzer in vitro conditions offered by manufacturer's data sheet. Since the parameter TCO(2) needed serum sample for measurement, we further derived a noninvasive model (model 2):Tpo(4) = 80.3 × C(45) - 0.024 × age + 0.07 × weight + 0.06 × clearance - 8.14. Coefficient of determination, root mean square error, and residual plots showed the appropriateness of two models. Model validation further suggested good and similar predictive ability of them. This study derived a noninvasive model to predict phosphate removal. It applies to patients treated by 4-hour HD under similar conditions.
准确评估血液透析（HD）过程中的磷清除情况对于改善维持性血液透析患者的磷控制至关重要。我们报告了一种简单的非侵入性模型，用于估计4小时血液透析过程中的磷清除情况。纳入了165例患者，他们每次使用聚砜（1.2 m²）或三醋酸（1.3 m²）制成的低通量透析器进行4小时的血液透析。血流量在180至300 mL/分钟之间变化。在4小时的血液透析治疗过程中收集透析液流出样本，以测量总磷清除量。获取透析前血清磷、钾、血细胞比容、完整甲状旁腺激素、总二氧化碳（TCO₂）、碱性磷酸酶水平以及临床和透析特征。随机选择135次观察结果用于模型构建，其余30次用于模型验证。4小时血液透析过程中的总磷清除量大多为15 - 30 mmol。预测总磷清除量的初级模型（模型1）为：Tpo₄ = 79.6 × C₄₅（mmol/L） - 0.023 × 年龄（岁） + 0.065 × 体重（kg） - 0.12 × TCO₂（mmol/L） + 0.05 × 清除率（mL/分钟） - 3.44，其中C₄₅是血液透析45分钟时测量的用过透析液中的磷浓度，清除率是制造商数据表提供的透析器在体外条件下的磷清除率。由于参数TCO₂需要血清样本进行测量，我们进一步推导了一个非侵入性模型（模型2）：Tpo₄ = 80.3 × C₄₅ -
