尿素清除指数联合尿素清除体积评估血液透析充分性  

Kt/V combined with Kt in assessing dialysis adequacy of hemodialysis patients

作　　者：陈晨 徐燕 蔡忠林 李晔 胡梦天 马春园 CHEN Chen;XU Yan;CAI Zhonglin;LI Ye;HU Mengtian;MA Chunyuan(Department of Nephrology,Suzhou Ninth People's Hospital,Suzhou 215200,China)

机构地区：[1]苏州市第九人民医院肾内科,苏州215200

出　　处：《肾脏病与透析肾移植杂志》2022年第6期525-530,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：苏州市第九人民医院科研基金(YK202224)。

摘　　要：目的:探讨尿素清除指数(Kt/V)联合尿素清除体积(Kt)评估血液透析(HD)充分性的必要性和合理性,分析影响HD充分性评价指标可靠性的因素。方法:采用单中心、横断面、前瞻性的研究设计,选取苏州市第九人民医院192例维持性血液透析(MHD)治疗的患者作为研究对象。检测单次透析前后血尿素氮,使用Daugirdas公式计算单室尿素清除指数(spKt/V)和Lowrie公式计算目标尿素清除体积(t-Kt),根据Kt/V和Kt达标情况进行分组,分析和探讨HD充分性指标与临床参数之间的关系,采用Logistic回归分析Kt/V的影响因素。结果:平均Kt/V值1.62±0.46,Kt/V达标率65.10%;平均Kt值53.53±15.88 L,Kt达标率53.13%;根据Kt/V分组比较:Kt/V未达标组Kt值低于Kt/V达标组(46.37±6.89 L vs 57.36±17.91 L,t=-6.08,P<0.01);Kt/V未达标组尿素分布容积(V)高于Kt/V达标组(37.96±5.18 L vs 31.10±4.90 L,t=9.07,P<0.01)。根据Kt/V和Kt联合分组,即A组(Kt/V和Kt均达标)、B组(Kt/V和Kt均不达标)、C组(Kt/V达标和Kt未达标)和D组(Kt/V不达标和Kt达标),四组患者占比分别为50.00%、30.21%、16.67%和3.13%。A组Kt值最高61.38±18.68 L。D组V值最高42.67±2.73 L。透析方式(OR=6.19)、V(OR=14.13)、Kt(OR=29.34)和基础代谢率(OR=0.19)是影响Kt/V的独立危险因素。结论:Kt/V联合Kt评估发现了“透析相对充分”和“透析相对不充分”的特殊人群,可以更全面、客观地评估患者的透析充分性。Objective:To explore the necessity and rationality of evaluating hemodialysis adequacy by urea clearance index(Kt/V)combined with volume of urea clearecl(Kt),in order to analyze the factors affecting hemodialysis adequacy.Methodology:Using single-center,cross-sectional and prospective study design,hemodialysis adequacy was assessed,and the hemodialysis patients were selected as research subjects from Suzhou Ninth People’s Hospital.Blood samples were collected for testing before and after dialysis;single-pool Kt/V was calculated according to the daugirdas formula.target-Kt was calculated according to the Lowrie’s formula.The study was grouped according to the compliance of Kt/V and Kt,and the relationship between hemodialysis adequacy and clinical parameters was analyzed.Meanwhile,the factors affecting Kt/V were analyzed by using logistic regression.Results:The Kt/V value was 1.62±0.46,and the number of Kt/V who met the standard was 125(65.10%);The Kt value was 53.53±15.88 L,and the number of Kt who met the standard was 102(53.13%).the Kt value of Kt/V non-standard group was lower than that of Kt/V standard group(46.37±6.89 L vs 57.36±17.91 L,t=-6.08,P<0.01);the value of V in Kt/V non-standard group was higher than that in Kt/V standard group(37.96±5.18 L vs 31.10±4.90 L,t=9.07,P<0.01).Patients were divided into four groups based on whether Kt/V and Kt were met the criteria,and they were Group A(Kt/V and Kt are both up to standard),Group B(Kt/V and Kt are not up to standard),Group C(Kt/V was up to but Kt was not up to standard)and Group D(Kt/V was not up to but Kt was up to standard).The proportions of patients in the four group was as follows:50.00%、30.21%、16.67%and 3.13%.Among them,Group A has the highest Kt value(61.38±18.68)L.Group D has the highest V value(42.67±2.73)L.Logistic regression analysis results shows that:Dialysis mode(OR=6.19)、V(OR=14.13)、Kt(OR=29.34)and BMR(OR=0.19)are independent risk factors which can affect Kt/V.Conclusion:Kt/V combined with Kt can identify special populati

关 键 词：血液透析 透析充分性 尿素清除指数 尿素清除体积 

分 类 号：R692.5[医药卫生—泌尿科学]