Murata G H, Tzamaloukas A H, Voudiklari S, Dimitriadis A, Balaskas E V, Nicolopoulou N, Dombros N
Veterans Affairs Medical Center and the University of New Mexico School of Medicine, Albuquerque 87108, USA.
Int J Artif Organs. 1998 Sep;21(9):515-20.
The purpose of this study was to determine if Kt/V urea in continuous ambulatory peritoneal dialysis (CAPD) could be estimated by a multivariate model based upon simple clinical observations. The study included 439 clearance studies in 301 CAPD patients followed in 8 dialysis centers. Weekly urea clearance, 24 h urine volume and 24 h drain volume were normalized to body water by the formulae of Watson (Kt/V, UV/V and DV/V respectively). Adequate dialysis was defined as Kt/V > or = 2.0 weekly. Subjects at 2 units were used to derive the models, while others were used for model validation. Stepwise multiple linear regression was performed on the derivation set (DS) to identify the clinical variables that correlated with Kt/V. The model was then used to estimate Kt/V for the validation set (VS). In the DS, 110 clearance studies were performed in subjects with residual renal function. Multiple linear regression showed that weekly Kt/V was defined by the expression: Kt/V=1.48 + 24.1 (UV/V) + 2.92(DV/V) - 0.049 (serum creatinine) (r=0.750, p<0.001). In 204 VS studies, the correlation between estimated and measured Kt/V was 0.633. There were marked differences in the proportion of adequately dialyzed patients when Kt/V estimated from the formula shown was <2.0, between 2.0 and 2.3, and >2.3 weekly (7.9%, 54.7% and 79.7%, respectively; p<O.001). In the 33 studies done in DS anuric patients, regression analysis showed the following: Kt/V=0.46 + 2.59 (DV/V) + O.009(age) (r=0.562; p=0.003). In 92 VS studies in anuric subjects, there was strong correlation between estimated and measured Kt/V (r=0.740). Again, there were marked differences in the frequency of adequate dialysis in anuric patients with estimated Kt/V <2.0, between 2.0 and 2.3, and >2.3 weekly (8.1%, 68.8%, and 100%, respectively; p<0.001). The risk of low Kt/V can be estimated by multivariate linear models requiring only simple clinical measurements.
本研究的目的是确定连续非卧床腹膜透析（CAPD）中的尿素Kt/V是否可通过基于简单临床观察的多变量模型进行估算。该研究纳入了8个透析中心随访的301例CAPD患者的439次清除率研究。通过Watson公式（分别为Kt/V、UV/V和DV/V）将每周尿素清除率、24小时尿量和24小时引流液量按身体水分进行标准化。充分透析定义为每周Kt/V≥2.0。2个单位的受试者用于推导模型，其他受试者用于模型验证。对推导集（DS）进行逐步多元线性回归，以确定与Kt/V相关的临床变量。然后使用该模型估算验证集（VS）的Kt/V。在DS中，对有残余肾功能的受试者进行了110次清除率研究。多元线性回归显示，每周Kt/V由以下表达式定义：Kt/V = 1.48 + 24.1（UV/V）+ 2.92（DV/V） - 0.049（血清肌酐）（r = 0.750，p < 0.001）。在204次VS研究中，估算的Kt/V与测量的Kt/V之间的相关性为0.633。当根据所示公式估算的Kt/V每周<2.0、在2.0至2.3之间以及>2.3时，充分透析患者的比例存在显著差异（分别为7.9%、54.7%和79.7%；p < 0.001）。在DS中对无尿患者进行的33次研究中，回归分析显示如下：Kt/V = 0.46 + 2.59（DV/V）+ 0.009（年龄）（r = 0.562；p = 0.003）。在对无尿受试者进行的92次VS研究中，估算的Kt/V与测量的Kt/V之间存在强相关性（r = 0.740）。同样，估算的Kt/V每周<2.0、在2.0至2.3之间以及>2.3的无尿患者充分透析的频率存在显著差异（分别为8.1%、68.8%和100%；p < 0.001）。低Kt/V风险可通过仅需简单临床测量的多元线性模型进行估算。
