摘要
目的 在氮平衡的基础上评价Kt/V这一经典的透析充分性评估指标在腹膜透析中的价值 ,探讨腹膜透析充分性的最佳评估指标。方法 在氮平衡的基础上推算持续性不卧床腹膜透析 (CAPD)患者的理论透析剂量及透析指数 (DI) ,并进一步推算氮平衡状态下的Kt/V计算公式 ;计算溶质转运指数(SRI)。比较透析指数 (DI)、溶质清除指数 (Kt/V)、溶质转运指数 (SRI)三者在评估透析充分性方面的优缺点。结果 溶质清除指数 (Kt/V)受饮食蛋白的摄入量及体重的影响 ,我们不能用同一个Kt/V值标准来评估不同条件下CAPD患者的透析充分状况。在CAPD状态下 ,溶质转运指数 (SRI)与Kt/V反映的数据是相同的 ,它反映的是溶质的清除量与该溶质在身体中总的含量之比。透析指数 (DI)可以反映在达到目标血尿素氮 (BUN)水平时不同体重、不同蛋白质摄入 (DPI)患者达到氮平衡状态时所需要的透析剂量 ,当不存在蛋白质摄入不足的情况下 ,它可以从氮平衡的角度反映透析的充分性。结论 对于临床处于稳定状态的CAPD患者 ,用透析指数 (DI)综合蛋白摄入量 (DPI)来评估其透析充分性较单纯目标尿素溶质清除指数Kt/V值及溶质转运指数 (SRI)更为客观可靠。
Objective Kt/V has been used to assess adequacy of peritoneal dialysis. However, Kt/V urea only reflects the clearance of solute without considering the effects of dietary protein intake (DPI). The objective of this study is to evaluate the value of Kt/V based on nitrogen balance and to study whether it is the best adequacy index. Methods On the premise that nitrogen balance is obtained, we calculate the minimal adequate dialysate volume and dialysis index (DI), Kt/V and solute removal index (SRI). We compared the values of DI、Kt/V and SRI in evaluating the adequacy of peritoneal dialysis. Results Kt/V changed with DPI and body weight in CAPD patient. We can not define adequate dialysis with a single value while DPI and body weight are different. For CAPD, SRI and Kt/V are numerically equal. However, dialysis index (DI) can reflect the minimal adequate dialysate volume when DPI and body weight changed and thus reflects the adequacy of dialysis. Conclusions DI reflects the balance between DPI and solute clearance. It is more objective to evaluate dialysis adequacy than Kt/V and SRI in clinical stable peritoneal dialysis patients.
出处
《中国血液净化》
2004年第8期413-415,437,共4页
Chinese Journal of Blood Purification
基金
中华人民共和国教育部长江学者奖励计划
教育部振兴行动计划专项基金 (985工程 )资助