Unaffiliated, San Clemente, California, USA.
Unaffiliated, Montreal, Québec, Canada.
Blood Purif. 2019;47(4):369-376. doi: 10.1159/000495022. Epub 2019 Jan 30.
High dialysate flow rates (QD) of 500-800 mL/min are used to maximize urea removal during conventional hemodialysis. There are few data describing hemodialysis with use of mid-rate QD (300 mL/min).
We constructed uremic solute (urea, beta2-microglobulin and phosphate) kinetic models at varying volumes of distribution and blood flow rates to predict solute clearances at QD of 300 and 500 mL/min.
Across a range of volumes of distribution a QD of 300 mL/min generally yields a predicted urea spKt/V greater than 1.2 during typical treatment times with a small difference in urea spKt/V between a QD of 300 and 500 mL/min. A larger urea KoA dialyzer and 15 min of additional time narrows the urea spKt/V difference. No substantial differences were observed regarding the kinetics of beta2-microglobulin and phosphate for QD of 300 vs. 500 mL/min.
A QD of 300 mL/min can achieve urea clearance targets. Hemodialysis systems using mid-rate QD can be expected to provide adequate hemodialysis, as currently defined.
高透析液流量（QD）为 500-800mL/min 用于在常规血液透析期间最大限度地清除尿素。很少有数据描述使用中速 QD（300mL/min）进行血液透析。
我们构建了尿毒症溶质（尿素、β2-微球蛋白和磷酸盐）的动力学模型，以在不同的分布容积和血流速度下预测 QD 为 300 和 500mL/min 时的溶质清除率。
在分布容积范围内，QD 为 300mL/min 在典型治疗时间内通常会产生大于 1.2 的预测尿素 spKt/V，而 QD 为 300 和 500mL/min 之间的尿素 spKt/V 差异较小。更大的尿素 KoA 透析器和 15 分钟的额外时间缩小了尿素 spKt/V 的差异。对于 QD 为 300 与 500mL/min，β2-微球蛋白和磷酸盐的动力学没有观察到实质性差异。
QD 为 300mL/min 可以达到尿素清除目标。目前定义的使用中速 QD 的血液透析系统可以预期提供足够的血液透析。
