Di Filippo S, Manzoni C, Corti M, Locatelli F
Department of Nephrology and Dialysis, Hospital of Lecco, Italy.
Int J Artif Organs. 1998 Sep;21(9):509-14.
A standard for quantifying the hemodialysis dose has not yet been defined. Many authors suggest the use of an alternative method to Kt/V: the solute removal index (SRI). We compared three methods based on blood-side urea determinations with the direct quantification method (DDQ) for estimating the delivered dialysis dose, expressed as SRI as well as Kt/V. Eight patients underwent three consecutive dialysis sessions, with the same dialytic efficiency. For each patient and each dialytic session the SRI and Kt/V were determined using the DDQ method and the single pool variable volume kinetic model, in its classical version (SPVV) as well by using the postdialysis urea value determined 30 min after the end of the session (eqSPVV). Double pool Kt/V was also estimated by the Daugirdas-Schneditz rate equation. Our results showed that the SPVV kinetic model significantly overestimated the delivered dialysis dose, the mean value of SRI and Kt/V were respectively 8.9% and 17% higher than those obtained by DDQ. The eqSPVV allowed the SRI to be estimated with a difference of -0.3% and Kt/V with a difference of -2% in comparison with DDQ. By using the Daugirdas-Schneditz rate of equation, which does not require blood samples to be drawn after the end of the session, the difference in Kt/V value was 3%. Therefore, both the eqSPVV kinetic model and the Daugirdas method allow quantification of the delivered dialysis dose with results similar to those determined by DDQ, which cannot be routinely applied. Kt/V seems the best marker for dialytic doses quantification.
目前尚未定义量化血液透析剂量的标准。许多作者建议使用Kt/V的替代方法：溶质清除指数（SRI）。我们将基于血液侧尿素测定的三种方法与直接定量法（DDQ）进行比较，以估算所给予的透析剂量，以SRI和Kt/V表示。八名患者连续进行了三次透析治疗，透析效率相同。对于每位患者和每次透析治疗，使用DDQ法、经典版本的单池可变容积动力学模型（SPVV）以及使用透析结束后30分钟测定的透析后尿素值（eqSPVV）来确定SRI和Kt/V。还通过Daugirdas-Schneditz速率方程估算双池Kt/V。我们的结果表明，SPVV动力学模型显著高估了所给予的透析剂量，SRI和Kt/V的平均值分别比DDQ法高出8.9%和17%。与DDQ相比，eqSPVV估算SRI的差异为 -0.3%，估算Kt/V的差异为 -2%。使用Daugirdas-Schneditz速率方程（该方程不需要在透析结束后采集血样），Kt/V值的差异为3%。因此，eqSPVV动力学模型和Daugirdas方法都能够对所给予的透析剂量进行量化，结果与DDQ法测定的结果相似，但DDQ法无法常规应用。Kt/V似乎是透析剂量量化的最佳指标。
