Robles N R, Gonzalez-Reymundo J, Cruz A, Gomez-Ainsua C, Calderon M T, Carande J
Sección de Nefrología, Hospital Infanta Cristina, Badajoz.
An Med Interna. 1996 Jan;13(1):21-4.
Urea kinetic-modelling was performed on 109 patients undergoing hemodialysis (518 urea kinetic studies). Then, the theoretic times for a target TAC = 50 mg/dl (TTAC) and a Kt/V = 1 (TKTV) were estimated. The differences and correlations of both times were calculated. Also the correlation of PCR and Kt/V was analyzed in relation to the range of Kt/V. For all cases no differences were found in dialysis session length (TTAC 221.4 +/- 42.6 min.; TKTV 222.9 +/- 48.9 min.). Mean Kt/V was 1.00 +/- 0.15 and mean TAC was 55.2 +/- 13.2. 313 studies (60.4%) have a TAC > 50 mg/dl. For Kt/V < 0.80, 15.6% have a TAC < 50 mg/dl, when Kt/V > 0.80 41.2% of cases have a TAC < 50 mg/dl (p < 0.01). A linear correlation of Kt/V and PCR was found (r = 0.36, p < 0.01). This correlation was stronger for Kt/V < 0.8 (r = 0.54, p < 0.01, n = 47). When TTAC was compared to TKTV a great variability was found: 20.1% have differences lesser than 15 minutes; and this difference was more than 30 minutes in 58.5%. In 107 cases (20.7%) the TTAC produced a Kt/V < 0.8. In all cases a significant (p < 0.01) linear correlation between TKTV and TTAC was found (r = 0.46). TKTV was greater than TTAC for real Kt/V < 1, and lesser than TTAC cuando the effective Kt/V was > 1. It is concluded that in patients treated by dialysis prescription of dialysis session length by TAC or by Kt/V produce rather different times for an unique patient. These differences are related to the PCR, which have a significant correlation with Kt/V. TAC tends toward under value dialysis session length in patients with inadequate dialysis.
对109例接受血液透析的患者进行了尿素动力学建模（共518次尿素动力学研究）。然后，估算了目标时间平均血药浓度（TAC）=50mg/dl时的理论时间（TTAC）和尿素清除率与体重比（Kt/V）=1时的理论时间（TKTV）。计算了这两个时间的差异和相关性。还分析了蛋白质分解代谢率（PCR）与Kt/V在Kt/V范围内的相关性。所有病例的透析时长均无差异（TTAC为221.4±42.6分钟；TKTV为222.9±48.9分钟）。平均Kt/V为1.00±0.15，平均TAC为55.2±13.2。313项研究（60.4%）的TAC>50mg/dl。当Kt/V<0.80时，15.6%的研究TAC<50mg/dl；当Kt/V>0.80时，41.2%的病例TAC<50mg/dl（p<0.01）。发现Kt/V与PCR呈线性相关（r=0.36，p<0.01）。这种相关性在Kt/V<0.8时更强（r=0.54，p<0.01，n=47）。将TTAC与TKTV进行比较时，发现差异很大：20.1%的差异小于15分钟；58.5%的差异超过30分钟。107例（20.7%）的TTAC得出的Kt/V<0.8。在所有病例中，均发现TKTV与TTAC之间存在显著的（p<0.01）线性相关（r=0.46）。对于实际Kt/V<1的情况，TKTV大于TTAC；而当有效Kt/V>1时，TKTV小于TTAC。得出结论，在接受透析治疗的患者中，根据TAC或Kt/V来规定透析时长，对于同一患者会产生相当不同的时间。这些差异与PCR有关，PCR与Kt/V存在显著相关性。在透析不充分的患者中，TAC往往会低估透析时长。
