增加透析液流速以提高透析剂量（Kt）是否有用？
Is it useful to increase dialysate flow rate to improve the delivered Kt?
作者信息
Albalate Marta, Pérez-García Rafael, de Sequera Patricia, Corchete Elena, Alcazar Roberto, Ortega Mayra, Puerta Marta
机构信息
Servicio de Nefrologia, Hospital Universitario Infanta Leonor, Gran Vía del Este, No 80, 28031, Madrid, Spain.
出版信息
BMC Nephrol. 2015 Feb 14;16:20. doi: 10.1186/s12882-015-0013-9.
BACKGROUND
Increasing dialysate flow rates (Qd) from 500 to 800 ml/min has been recommended to increase dialysis efficiency. A few publications show that increasing Qd no longer led to an increase in mass transfer area coefficient (KoA) or Kt/V measurement. Our objectives were: 1) Studying the effect in Kt of using a Qd of 400, 500, 700 ml/min and autoflow (AF) with different modern dialysers. 2) Comparing the effect on Kt of water consumption vs. dialysis time to obtain an individual objective of Kt (Ktobj) adjusted to body surface.
METHODS
This is a prospective single-centre study with crossover design. Thirty-one patients were studied and six sessions with each Qd were performed. HD parameters were acquired directly from the monitor display: effective blood flow rate (Qbe), Qd, effective dialysis time (Te) and measured by conductivity monitoring, final Kt.
RESULTS
We studied a total of 637 sessions: 178 with 500 ml/min, 173 with 700 ml/min, 160 with AF and 126 with 400 ml/min. Kt rose a 4% comparing 400 with 500 ml/min, and 3% comparing 500 with 700 ml/min. Ktobj was reached in 82.4, 88.2, 88.2 and 94.1% of patients with 400, AF, 500 and 700 ml/min, respectively. We did not find statistical differences between dialysers. The difference between programmed time and Te was 8' when Qd was 400 and 500 ml/min and 8.8' with Qd = 700 ml/min. Calculating an average time loss of eight minutes/session, we can say that a patient loses 24' weekly, 312' monthly and 62.4 hours yearly. Identical Kt could be obtained with Qd of 400 and 500 ml/min, increasing dialysis time 9.1' and saving 20% of dialysate.
CONCLUSIONS
Our data suggest that increasing Qd over 400 ml/min for these dialysers offers a limited benefit. Increasing time is a better alternative with demonstrated benefits to the patient and also less water consumption.
背景
已建议将透析液流速（Qd）从500 ml/min提高至800 ml/min以提高透析效率。一些出版物表明，提高Qd不再会导致传质面积系数（KoA）或Kt/V测量值增加。我们的目标是：1）研究使用400、500、700 ml/min的Qd以及自动流量（AF）与不同现代透析器时对Kt的影响。2）比较水消耗与透析时间对Kt的影响，以获得根据体表面积调整的个体Kt目标值（Ktobj）。
方法
这是一项采用交叉设计的前瞻性单中心研究。研究了31名患者，每个Qd进行6次透析治疗。血液透析参数直接从监测器显示屏获取：有效血流量（Qbe）、Qd、有效透析时间（Te），并通过电导率监测测量最终Kt。
结果
我们总共研究了637次透析治疗：178次Qd为500 ml/min，173次Qd为700 ml/min，160次为AF，126次Qd为400 ml/min。将400 ml/min与500 ml/min相比，Kt升高了4%；将500 ml/min与�00 ml/min相比，Kt升高了3%。使用400、AF、500和700 ml/min时，分别有82.4%、88.2%、88.2%和94.1%的患者达到了Ktobj。我们未发现不同透析器之间存在统计学差异。当Qd为400和500 ml/min时，设定时间与Te之间的差异为8分钟；当Qd = 700 ml/min时，差异为8.8分钟。计算每次透析治疗平均时间损失8分钟，我们可以说患者每周损失24分钟，每月损失312分钟，每年损失62.4小时。使用400和500 ml/min的Qd可获得相同的Kt，透析时间增加9.1分钟，并节省20%的透析液。
结论
我们的数据表明，对于这些透析器，将Qd提高到400 ml/min以上带来的益处有限。增加透析时间是更好的选择，对患者有明显益处，且耗水量更少。
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