Daugirdas John T
Semin Dial. 2014 Mar;27(2):98-107. doi: 10.1111/sdi.12201.
Current views regarding hemodialysis adequacy reach beyond indices of small solute removal such as Kt/V. Nevertheless, new Kt/V-based constructs such as the standard Kt/V, which adjusts not only for dialysis frequency, but which also represents removal of sequestered solutes rather than easily removed urea, continue to be useful. The scaling of dialysis dose to measures of size other than body water results in higher recommended doses of dialysis for children, small patients, and women, compared with the current body water-based scaling approach. Aside from small solute removal, increasing weekly time on dialysis results in slower removal of fluid with better tolerance and with increased removal of phosphorus, although both salt and water and phosphorus control often respond to efforts to reduce intake. The intermediate term benefits of removing larger middle molecules such as beta-2-microglobulin appear to be modest, and the benefits of removal of protein-bound uremic toxins remain to be proved in controlled trials.
目前关于血液透析充分性的观点已超越诸如Kt/V等小分子溶质清除指标。然而，基于Kt/V的新指标，如标准Kt/V，不仅能根据透析频率进行调整，还能反映被隔离溶质的清除情况，而非易清除的尿素，这些指标仍然有用。与当前基于身体水分的剂量换算方法相比，将透析剂量换算为除身体水分之外的其他尺寸指标，会导致儿童、体型较小的患者和女性的推荐透析剂量更高。除小分子溶质清除外，增加每周透析时间会使液体清除速度减慢，但耐受性更好，同时磷清除增加，尽管盐、水和磷的控制通常会对减少摄入量的努力做出反应。清除较大的中分子物质（如β2微球蛋白）的中期益处似乎不大，而清除与蛋白质结合的尿毒症毒素的益处仍有待在对照试验中得到证实。
