维持性血液透析后血清尿素反弹及其影响因素研究

Post-hemodialytic urea rebound and its impact factors in Chinese maintenance dialysis patients

目的观察维持性血液透析患者透析后血清尿素反弹情况,并研究相关影响因素。方法选取稳定的维持性血液透析患者50例,取透析前、透析结束时、透析后15和30min的血样,定量观察尿素反弹及其对透析充分性指标单室尿素清除指数(spKt/V)和血清尿素下降率(URR)的影响,并分析其与患者人口学特征、透析参数的相关关系。结果血液透析后的血清尿素反弹平均达13.6%,导致URR和spKt/V分别高估0.04个百分点和0.14个单位。影响尿素反弹最重要的因素是透析效率K/V,此外还有较高的血红蛋白、较多的相对超滤量、动脉-静脉通路和男性。结论血液透析后的尿素反弹是普遍存在的现象,对于特定的个体和透析过程,其对充分性指标的影响不能忽略。

Objective To observe the urea rebound after hemodialysis in Chinese maintenance dialysis patients,and explore its impact factors.Methods In 50 stable the hemodialysis patients,blood samples were taken at the beginning,immediate post-dialysis,15 minutes and 30 minutes after ending of dialysis.The urea rebound was quantified,as well as its effect on URR and Kt/V.The impact factors on urea rebound were analyzed.Results In this group of patients,average post-dialytic urea rebound was 13.6%,leading to over-estimation of URR and Kt/V of 0.04 and 0.14,respectively.Hemodialysis efficiency expressed as K/V determined urea rebound most significantly.Other impact factors included higher hemoglobin,higher relative ultrafiltration,arterial-venous access,and male patients.Conclusion Urea rebound was common after the end of hemodialysis.For specific patients and hemodialysis sessions,ignoring it would lead to significant over-estimation of delivered hemodialysis dose.