对透析充分性的认识更新

Update on hemodialysis adequacy

spKt/Vurea是指用第二代单室可变体积尿素动力学模型估计的尿素清除指数,它只能用来表示单次透析对小分子非蛋白结合毒素的清除是否充分。要表示这类毒素的清除是否充分,需要计算std Kt/Vurea。可以用增加透析次数的手段提高std Kt/Vurea,以改善患者长期存活。当前还没有评价蛋白结合溶质、中大分子溶质、在体液不均匀分布溶质的透析充分性,的公认方法。

spK t/Vurea is the urea clearance index calculated using the second generation single pool volume-varying urea kinetic model, which can only be used to indicate the dialysis adequacy for non-protein bounded small molecular weight solutes from a single dialysis session. To indicate if these kind of solute is adequately cleared for the time run, stdKt/Vurea should be calculated. To improve patients＇ long term outcome, he frequency of dialysis can be increased to reach a higher stdKt/Vurea. It is still unclear how to evaluate the dialysis adequacy for protein-bounded solutes, middle and high molecular weight solutes, and solutes unevenly distributed in body fluid.