透析频率和间期对Kt/V的影响

The influence of dialysis frequency and interval on calculation of Kt/V

目的比较修订尿素产生因子(GFAC)对单室尿素清除指数(sp Kt/V)以及由此计算的平衡Kt/V(e Kt/V)和标准Kt/V(std Kt/V)的影响。方法选取在北京大学人民医院行维持性血液透析,但透析次数非每周3次或虽是每周3次但非相隔2 d采血的患者95例。以日常工作中使用的0.008为GFAC计算sp Kt/V1、e Kt/V1和std Kt/V1;再用根据透析频率及透析间期修订的GFAC值计算sp Kt/V2、e Kt/V2、std Kt/V2;将sp Kt/V1、e Kt/V1、std Kt/V1分别与sp Kt/V2、e Kt/V2、std Kt/V2进行比较。结果 sp Kt/V1与sp Kt/V2(1.538±0.357 vs.1.504±0.341),e Kt/V1与e Kt/V2(1.525±0.315 vs.1.495±0.301),std Kt/V1与std Kt/V2(2.298±0.230 vs.2.279±0.230)比较差异均有统计学意义(P<0.01)。结论将GFAC=0.008用于不符合尿素动力学模型要求的患者会高估透析充分性,应根据不同透析频率和采血时间使用不同的GFAC值,以更准确估计sp Kt/V、e Kt/V及std Kt/V。

Objective To compare the influence of the urea generation factor(GFAC) modification on sp Kt/V,balanced Kt/V(e Kt/V) and standardized Kt/V(std Kt/V), where e Kt/V and std Kt/V were estimated from sp Kt/V. Methods Ninety- five hemodialysis patients who were dialyzed except three times per week or not 2- day preceding interdialysisinterval for 3/week from the Peking University People's Hospital were included in this study. The value of sp Kt/V1 wasestimated using GFAC=0.008, and e Kt/V1 and std Kt/V1 were estimated. Using modified GFAC, sp Kt/V2, e Kt/V2 and std Kt/V2 were estimated. The sp Kt/V1, e Kt/V1 and std Kt/V1 were compared with sp Kt/V2, e Kt/V2 and std Kt/V2. Results Therewere significant differences between sp Kt/V1 and sp Kt/V2(1.538±0.357 vs. 1.504±0.341), e Kt/V1 and e Kt/V2(1.525±0.315 vs. 1.495±0.301), std Kt/V1 and std Kt/V2(2.298±0.230 vs. 2.279±0.230), respectively(P<0.01). Conclusion Using GFAC=0.008 in equation for patients who were not matched the urea kinetic model could overestimate sp Kt/V, and hence, using themodified GFAC based on the dialysis schedules and the day of blood drawn can be more accurately to estimate the sp Kt/V,e Kt/V and std Kt/V.