Ficheux A, Gayrard N, Duranton F, Guzman C, Szwarc I, Vetromile F, Brunet P, Servel M F, Argilés A
RD - Néphrologie and Groupe Rein et HTA, EA7288, Université de Montpellier, Montpellier cedex, France.
Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, Sète, France.
Nephrol Dial Transplant. 2017 Feb 1;32(2):364-370. doi: 10.1093/ndt/gfw370.
Recent randomized controlled trials suggest that sufficiently high convection post-dilutional haemodiafiltration (HC-HDF) improves survival in dialysis patients, consequently this technique is increasingly being adopted. However, when performing HC-HDF, rigorous control systems of the ultrafiltration setting are required. Assessing the global ultrafiltration coefficient of the dialysis system [GKD-UF; defined as ultrafiltration rate (QUF)/transmembrane pressure] or water permeability may be adapted to the present dialysis settings and be of value in clinics.
GKD-UF was determined and its reproducibility, variability and influencing factors were specifically assessed in 15 stable patients routinely treated by high-flux haemodialysis or HC-HDF in a single unit.
GKD-UF invariably followed a parabolic function with increasing QUF in dialysis and both pre- and post-dilution HC-HDF (R2 constantly >0.96). The vertex of the parabola, GKD-UF-max and related QUF were very reproducible per patient (coefficient of variation 3.9 ± 0.6 and 3.3 ± 0.3%, respectively) and they greatly varied across patients (31–42 mL/h−1/mmHg and 82–100 mL/min, respectively). GKD-UF-max and its associated QUF decreased during dialysis treatment (P < 0.01). The GKD-UF-max decrease was related to weight loss (R2 = 0.66; P = 0.0015).
GKD-UF is a reliable and accurate method to assess the water permeability of a system in vivo. It varies according to dialysis setting and patient-related factors. It is an objective parameter evaluating the forces driving convection and identifies any diversion of the system during the treatment procedure. It is applicable to low- or high-flux dialysis as well as pre- or post-dilution HDF. Thus, it may be used to describe the characteristics of a dialysis system, is suitable for clinical use and may be of help for personalized prescription.
近期的随机对照试验表明，充分高的对流后稀释血液透析滤过（HC-HDF）可提高透析患者的生存率，因此该技术的应用日益广泛。然而，在进行HC-HDF时，需要对超滤设置进行严格的控制系统。评估透析系统的总体超滤系数[GKD-UF；定义为超滤率（QUF）/跨膜压]或水通透性可能适用于当前的透析设置，并且在临床上具有价值。
在一个单位中，对15例接受高通量血液透析或HC-HDF常规治疗的稳定患者测定GKD-UF，并具体评估其重现性、变异性和影响因素。
在透析以及前稀释和后稀释HC-HDF中，GKD-UF始终随QUF增加呈抛物线函数变化（R2始终>0.96）。抛物线的顶点、GKD-UF-max及相关的QUF在每个患者中具有很高的重现性（变异系数分别为3.9±0.6和3.3±0.3%），且在患者之间差异很大（分别为31–42 mL/h−1/mmHg和82–100 mL/min）。GKD-UF-max及其相关的QUF在透析治疗期间下降（P<0.01）。GKD-UF-max的下降与体重减轻有关（R2 = 0.66；P = 0.0015）。
GKD-UF是一种可靠且准确的体内评估系统水通透性的方法。它根据透析设置和患者相关因素而变化。它是评估驱动对流的力并识别治疗过程中系统任何偏差的客观参数。它适用于低通量或高通量透析以及前稀释或后稀释血液透析滤过。因此，它可用于描述透析系统的特征，适用于临床使用，可能有助于个性化处方。
