单室尿素清除指数联合尿素清除体积评估维持性血液透析患者透析充分性研究  

spKt/V Combined with Kt in Assessing Dialysis Adequacy in Hemodialysis Patients

作　　者：张艳 刘勇 ZHANG Yan;LIU Yong(The First Affiliated Hospital of Wannan Medical College,Department of the Blood Purification)

机构地区：[1]皖南医学院第一附属医院血液净化中心,安徽芜湖241001

出　　处：《长治医学院学报》2024年第5期345-349,共5页Journal of Changzhi Medical College

基　　金：2022年自然科学类校级中青年项目(WK2022F15)。

摘　　要：目的:探讨单室尿素清除指数(spKt/V)与尿素清除体积(Kt)对维持性血液透析(MHD)患者透析充分性的评估意义。方法:回顾性分析152例行血液透析患者的病史资料、透析资料和化验数据,使用Daugirdas公式计算spKt/V和Lowrie公式计算目标尿素清除体积(t-Kt),根据spKt/V达标情况分为spKt/V≥1.4组(A组)和spKt/V<1.4组(B组);根据spKt/V联合Kt达标情况分为4组:spKt/V≥1.4且Kt≥t-Kt组(AA组)、spKt/V≥1.4且Kt<t-Kt组(AB组)、spKt/V<1.4且Kt≥t-Kt组(BA组)、spKt/V<1.4且Kt<t-Kt组(BB组),探究组间各参数的关系,采用多因素Logistic回归分析spKt/V的影响因素。结果:152例MHD患者平均年龄(53.41±11.91)岁,平均spKt/V为1.59±0.39,spKt/V≥1.4有104例(68.42%),平均Kt为(54.76±11.27)L,Kt≥t-Kt有122例(80.26%);分组比较,B组体质量、体表面积(BSA)、基础代谢率(BMR)、体质量指数(BMI)、尿素分布容积(V)均高于A组,差异均有统计学意义(P<0.05),B组Kt低于A组(P<0.05),BA组V值最高,AB组V值最低,AA组Kt值最高,透前尿素氮是spKt/V的保护因素,尿素分布容积是spKt/V的独立危险因素。结论:V是spKt/V的独立影响因素,spKt/V联合Kt可细化分组,可更准确、个体化评估透析充分性。Objective:To explore the significance of single-compartment urea clearance index(spKt/V)and urea clearance volume(Kt)in the evaluation of dialysis adequacy in maintenance hemodialysis(MHD)patients.Methods:The medical history data,dialysis data and laboratory data of 152 hemodialysis patients were collected retrospectively.Daugirdas formula was used to calculate spKt/V and Lowrie formula was used to calculate target urea clearance volume(t-Kt).The patients were divided into two groups according to spKt/V:spKt/V≥1.4 group(Group A)and spKt/V<1.4 group(Group B).Patients were divided into 4 groups according to the standard of spKt/V combined Kt:spKt/V≥1.4 and Kt≥t-Kt group(AA group),spKt/V≥1.4 and Kt<t-Kt group(AB group),spKt/V<1.4 and Kt≥t-Kt group(BA group),spKt/V<1.4 and Kt<t-Kt group(BB group).The relationship between the parameters of the groups were investigated.Multivariate logistic regression was used to analyze the influencing factors of spKt/V.Results:Among the 152 MHD patients,the mean age was(53.41±11.91)years old,the mean spKt/V was 1.59±0.39,104 patients(68.42%)were spKt/V≥1.4,the mean Kt was(54.76±11.27)L,and 122 patients(80.26%)were Kt≥t-Kt.Compared among groups,body weight,body surface area(BSA),basal metabolic rate(BMR),body mass index(BMI)and volume urea of distribution(V)in group B were significantly higher than those in group A(P<0.05),Kt in group B was significantly lower than that in group A(P<0.05),and V value in group BA was the highest,the V in group AB was the lowest,and the Kt value in group AA was the highest.Urea nitrogen was a protective factor for spKt/V before perituration,and the urea distribution volume was an independent risk factor for spKt/V.Conclusion:V is an independent influencing factor of spKt/V,and spKt/V combined with Kt can be refined into subgroups to assess dialysis adequacy more accurately and individually.

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：R695.2[医药卫生—泌尿科学]