个体化血液透析：使用更少的水是否可以达到类似的透析充分性？

Individualized hemodialysis: Is similar hemodialysis adequacy possible using less water?

机构信息

Department of Internal Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkiye.

Division of Nephrology, Department of Internal Medicine, Konya City Hospital, Konya, Turkiye.

出版信息

Turk J Med Sci. 2023 Oct 10;53(6):1863-1869. doi: 10.55730/1300-0144.5756. eCollection 2023.

DOI:10.55730/1300-0144.5756

PMID:38813487

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10760548/

Abstract

BACKGROUND AND AIM

There are over 60,000 hemodialysis (HD) patients in Türkiye, and the number of patients is increasing yearly. Dialysate flow rate (Qd) is a factor in HD adequacy. Approximately 150 L of water are consumed per session to prepare the dialysate. We aimed to investigate whether HD effectiveness can be achieved at a low Qd in different patient groups for the purpose of saving water.

MATERIALS AND METHODS

This prospective study included 81 HD patients from 2 centers. The patients underwent an aggregate total of 486 HD sessions, including 3 sessions at a Qd of 500 mL/min and 3 sessions at a Qd of 300 mL/min for each patient. We used online Kt/V readings recorded at the end of each dialysis session to compare the effectiveness of these 2 types of HD session performed at a different Qd.

RESULTS

The online Kt/V readings were similar between the standard (500) and low (300) Qd HD (1.51 ± 0.41 and 1.49 ± 0.44, respectively, p = 0.069). In the subgroup analyses, men had higher online Kt/V values at the standard Qd compared to the low Qd (1.35 ± 0.30 and 1.30 ± 0.32, respectively, p = 0.019), but the Kt/V values were not different for women. While the low Qd did not reduce online Kt/V in patients using small surface area dialysis membranes (1.75 ± 0.35 for 300 Qd and 1.75 ± 0.32 for 500 Qd, p = 0.931), it was associated with reduced online Kt/V in patients using large surface area dialysis membranes (1.12 ± 0.25 for 300 Qd and 1.17 ± 0.24 for 500 Qd, p = 0.006). The low Qd did not result in differences in online Kt/V among low-weight patients. However, online Kt/V values were better with the standard Qd in patients weighing 65 kg and above.

CONCLUSION

In our study, dialysis adequacy at a reduced dialysate flow was not inferior for women, patients with low body weight, or patients using small surface area membranes. Individualized HD at a reduced Qd of 300 mL/min in eligible patients can save 48 L of water per HD session and an average of 7500 L of water per year.

摘要

背景与目的

土耳其有超过 60000 名血液透析（HD）患者，且患者人数每年都在增加。透析液流量（Qd）是 HD 充分性的一个因素。每次治疗大约需要消耗 150 升水来准备透析液。我们旨在研究在不同患者群体中，低 Qd 是否可以达到 HD 效果，以达到节水的目的。

材料与方法

本前瞻性研究纳入了来自 2 个中心的 81 名 HD 患者。这些患者共接受了 486 次 HD 治疗，其中每位患者各进行了 3 次 Qd 为 500mL/min 的治疗和 3 次 Qd 为 300mL/min 的治疗。我们使用每次透析结束时在线记录的 Kt/V 值来比较这两种不同 Qd 下 HD 治疗的效果。

结果

标准（500）和低（300）Qd HD 的在线 Kt/V 值相似（分别为 1.51±0.41 和 1.49±0.44，p=0.069）。在亚组分析中，男性在标准 Qd 下的在线 Kt/V 值高于低 Qd（分别为 1.35±0.30 和 1.30±0.32，p=0.019），但女性的 Kt/V 值无差异。虽然低 Qd 不会降低使用小表面积透析膜的患者的在线 Kt/V 值（300 Qd 时为 1.75±0.35，500 Qd 时为 1.75±0.32，p=0.931），但它与使用大表面积透析膜的患者的在线 Kt/V 值降低相关（300 Qd 时为 1.12±0.25，500 Qd 时为 1.17±0.24，p=0.006）。低 Qd 不会导致低体重患者的在线 Kt/V 值出现差异。然而，在体重 65kg 及以上的患者中，标准 Qd 的在线 Kt/V 值更好。