腹膜透析患者容量超负荷对溶质清除的影响  

The interaction between volume overload and solute clearance in peritoneal dialysis patients

作　　者：王亮凯[1] 唐雯[1] 余洪磊[1] 陈君忆[1] 汪涛[1] 

机构地区：[1]北京大学第三医院肾内科,北京100191

出　　处：《中国血液净化》2013年第7期358-361,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金项目(30900681);北京市科技计划项目(D09050704310905);北京大学第三医院中青年骨干基金

摘　　要：目的通过Watson公式计算体内的水及尿素清除率已经被广泛地应用在腹膜透析患者的透析充分性评估上。然而,尽管目前利用Watson公式计算体内总水分(TBWWatson)的方法已经很明确,但是Watson公式是基于正常容量的人群推导出来的,腹膜透析患者体内容量负荷状态对TBWWatson及尿素Kt/V的影响还很少被研究,因此我们在本研究中探索了利用Kt/V去评价腹膜透析患者透析充分性中存在的问题。方法本研究纳入了195位临床稳定的腹膜透析患者。分别通过多频生物电阻抗测试法(MF-BIS)以及经由Watson公式计算出体内总水分(TBW)并进行相互比较,并进一步分析通过两种方式计算得到的尿素Kt/V的差别。结果根据MF-BIS方法测得的患者体内容量状况值(OH)将患者分为3组:正常容量组(n=101,OH<2.0L)、轻中度容量超负荷组(n=61,OH=2.0～4.0L)和重度容量超负荷组(n=33,OH>4.0L)。与MF-BIS相比之下,Watson公式在正常容量组的TBW值评估显著过高,而在重度容量超负荷组的患者又显得评估显著过低。另一方面,根据Watson公式得出的Kt/V在正常容量患者组中显著低于MF-BIS方法,但在重度容量超负荷组中却显著高于MF-BIS方法。结论不同容量状况对腹膜透析患者通过Watson公式计算总体水及尿素Kt/V有很大的影响。Objective Urea clearance, adjusted for total body water using the Watson formula （Kt/Vurea） is widely used to guide peritoneal dialysis prescription and ensure dialysis adequacy. The impact of body composi- tion on determining body water using the Watson formula （TBWWatson） is well established, but the effect of hydration on TBWWatson and Kt/V is not well understood. We therefore in the present study tried to estimate the magnitude of errors in using Kt/V to assess dialysis adequacy in peritoneal dialysis patients. Methods A total of 195 stable adult peritoneal dialysis patients were enrolled. Total body water was measured by multiple-frequency bioelectrical impedance spectroscopy （MF-BIS） and compared with the TBW calculated using the Watson formula. Furthermore we calculated KgV by two methods - one is normalized to total body water according to Watson formula and the other is normalized to total body water according to MF-BIS. Results Patients were divided into three groups according to their degree of overhydration （OH, Ahydration status）： normally hydrated group （n=101, OH〈2.0L）, mildly overhydrated group （n=61, OH=2.0-4.0L）, and severely overhydrated group （n=33, OH〉4.0L）. Compared with MF-BIS, the Watson formula overestimated TBW in normally hydrated patients but underestimated TBW in severely overhydrated patients. On the other hand, compared with the Kt/V normalized to total body water according to MF-BIS, the Kt/V normalized to total body water according to Watson formula clearly underestimated Kt/V in normally hydrated patients but overestimated Kg/V in severely ove hydrated patients. Conclusion Our study suggested that hydration status strongly affected total body water estimation by the Watson formula in peritoneal dialysis patients, potentially leading to inappropriate dialysis prescription and failure to achieve recognized Kt/Vurea adequacy targets.

关 键 词：生物电阻抗 腹膜透析 容量负荷 Watson公式 透析充分性 

分 类 号：R459.5[医药卫生—治疗学]