Cegléd Dialysis Unit, Fresenius Medical Care, Cegléd, Hungary.
Department of Medicine, Szent Rókus Hospital, Baja, Hungary.
Artif Organs. 2020 Oct;44(10):1021-1030. doi: 10.1111/aor.13762. Epub 2020 Jul 27.
In an era of evidence-based medicine and dialysis performance measures, there is strong motivation to find specific, objective, quantifiable, and reproducible parameters to characterize the clinical condition of chronic kidney disease patients and to present population-wide statistics that may describe quality of care in dialysis centers. Yet, in the last three decades, several studies demonstrated that while parameters including Kt/V urea, serum phosphorus, parathyroid hormone, serum cholesterol fulfill all these criteria, efforts to optimize these lab parameters failed to improve survival on dialysis. However, subjective assessments of nutrition including subjective global assessment and malnutrition-inflammation score, while not ideally suited for statistical analysis and not optimal from the point of view of scientific methodology due to their general, semi-quantifiable, subjective nature have, nevertheless, proved themselves as some of the strongest predictors of clinical outcomes in the dialysis population. Where does this paradox leave us? We propose that a deeper understanding of relevance of these variables in the dialysis population may improve appreciation of the clinical situation of individual patients and may result in a paradigm shift from dialysis adequacy to quality dialysis.
在循证医学和透析绩效评估的时代，人们强烈希望找到具体、客观、可量化和可重复的参数来描述慢性肾脏病患者的临床状况，并提供可能描述透析中心护理质量的人群统计学数据。然而，在过去的三十年中，多项研究表明，尽管包括 Kt/V 尿素、血清磷、甲状旁腺激素、血清胆固醇在内的参数符合所有这些标准，但优化这些实验室参数的努力并未改善透析患者的生存率。然而，包括主观整体评估和营养不良-炎症评分在内的营养主观评估，尽管不适合进行统计分析，并且从科学方法的角度来看不是最佳的，因为它们具有一般性、半定量和主观性，但它们已被证明是透析人群临床结局的最强预测因素之一。这个悖论将我们置于何处？我们提出，深入了解这些变量在透析人群中的相关性可能会提高对个体患者临床情况的认识，并可能导致从透析充分性向优质透析的范式转变。
