Canaud B, Bosc J Y, Leblanc M, Garred L J, Vo T, Mion C
Lapeyronie Hospital, University of Montpellier, France.
Am J Kidney Dis. 1998 Jan;31(1):74-80. doi: 10.1053/ajkd.1998.v31.pm9428455.
On-line urea monitoring of the effluent dialysate offers a real-time assessment of dialysis efficiency and metabolic/nutritional characteristics of hemodialysis patients. Quantitative parameters were evaluated by dialysate urea kinetic modeling (DUKM) with an on-line urea sensor in 23 patients treated by high-flux hemodiafiltration (HDF) (215 sessions of 210 to 240 minutes with a mean blood flow rate of 367 +/- 44 mL/min). Overall, the mean effective Kt/V was 1.52 +/- 0.29, the urea mass removed (22.8 +/- 5.5 g/session or 814 +/- 198 mmol/session), the solute removal index (SRI) 73% +/- 6.1%, and the mean normalized protein catabolic rate (nPCR), 1.15 +/- 0.31 g/kg/day. Blood urea kinetic modeling (BUKM), based on pre- and postsession urea concentrations, using equations from Daugirdas and Garred to calculate equilibrated Kt/V and nPCR, respectively, were in good agreement with DUKM, the differences observed appearing not clinically relevant. The variability of evaluated parameters was verified over consecutive sessions for a mean period of 3 weeks in the entire group. Mean variation in Kt/V was 8%; in urea mass removal, 18%; and in nPCR, 18%. When assessed over 1 week in a subgroup of 13 patients, Kt/V and PCR remained relatively stable, and urea mass removal per- and postsession declined from 23.5 +/- 8.0 g (840 +/- 285 mmol) to 18.7 +/- 6.3 g (667 +/- 225 mmol) from the first to the third session of the week, most likely as a consequence of interdialytic intervals. Predialysis urea concentrations followed the same trend. In the current study, DUKM with on-line urea sensor has confirmed that HDF is a highly efficient renal replacement modality; the variability observed in quantitative parameters supports a need for frequent adequacy monitoring. On-line urea monitoring of effluent dialysate is a simple device that provides the opportunity to tailor treatment to patient needs.
对流出的透析液进行在线尿素监测可实时评估血液透析患者的透析效率及代谢/营养特征。采用在线尿素传感器，通过透析液尿素动力学建模（DUKM）对23例接受高通量血液透析滤过（HDF）治疗的患者（215次治疗，每次210至240分钟，平均血流量为367±44 mL/分钟）的定量参数进行了评估。总体而言，平均有效Kt/V为1.52±0.29，尿素清除量（每次治疗22.8±5.5 g或814±198 mmol/次），溶质清除指数（SRI）为73%±6.1%，平均标准化蛋白分解代谢率（nPCR）为1.15±0.31 g/kg/天。基于透析前后尿素浓度的血液尿素动力学建模（BUKM），分别使用Daugirdas和Garred的公式计算平衡Kt/V和nPCR，与DUKM结果高度一致，观察到的差异在临床上似乎并不相关。在整个组中，对连续治疗 sessions 进行了为期3周的平均时间的评估参数变异性验证。Kt/V的平均变化为8%；尿素清除量为18%；nPCR为18%。在13例患者的亚组中进行为期1周的评估时，Kt/V和PCR保持相对稳定，从本周的第一次治疗到第三次治疗，透析前后的尿素清除量从23.5±8.0 g（840±285 mmol）降至18.7±6.3 g（667± 225 mmol），这很可能是透析间期的结果。透析前尿素浓度遵循相同趋势。在本研究中，带有在线尿素传感器的DUKM已证实HDF是一种高效的肾脏替代方式；定量参数中观察到的变异性支持需要频繁进行充分性监测。对流出透析液进行在线尿素监测是一种简单的设备，为根据患者需求调整治疗提供了机会。
