透析不充分血液透析患者临床特征的多中心调查

Clinical characteristics of inadequate dialysis in hemodialysis patients: a multicenter inves tigation

目的探讨透析不充分血液透析患者的临床特征,为临床诊疗中提高透析充分性提供依据。方法本研究为多中心横断面调查,收集2018年1月~3月期间12家血液透析中心单室尿素模型Kt/V(single pool Kt/V,spKt/V)<1.2患者的人口统计学资料、治疗处方数据、实际治疗数据及残余肾功能测定数据等。使用SPSS 22.0统计软件进行数据分析,采用Spearman相关分析检验透析后体质量与血流速(blood flow rate,BFR)及体质量标化BFR之间的相关关系。结果本研究共入组224例患者,平均年龄(58.2±13.3)岁,男女比为5.2:1,处方spKt/V为(1.39±0.29),实测spKt/V为(1.06±0.11)。其中有117例(52.2%)患者处方spKt/V<1.4,其透析器尿素清除率(t=-8.619,P<0.001)、BFR(t=-3.846,P<0.001)和体质量标化的BFR(t=-12.577,P<0.001)均显著低于spKt/V≥1.4组;224例患者中,随着体质量的增加,体质量标化的BFR逐渐降低(ρ=-0.666,P<0.001)。有42例(18.8%)患者单次透析时间不足240min。有35例(15.6%)患者发生透析器凝血。有87例患者(38.84%)存在残余肾功能,但仅有14例进行了残余肾功能检测,其中有5例患者在合并计算残余肾功能后的Kt/V达标。结论血液透析患者透析不充分与处方Kt/V低、体质量标化的血流速低、透析时间不足、透析器凝血、透析充分性计算方法不合理、透析过程中的急性并发症等原因有关。

Objective The purpose of this study was to investigate the clinical characteristics of inadequate dialysis in hemodialysis patients,so as to provide the evidences for improving clinical diagnosis and treatment of inadequate dialysis and promoting dialysis adequacy.Methods This study was a multi-center and cross-sectional survey.We retrospectively analyzed the patients with the single pool Kt/V(spKt/V)<1.2 in a measurement during January to March 2018 from 12 centers.Their demographic,treatment prescription,actual treatment and residual renal function data were collected and analyzed.SPSS 22.0 statistical software was used for data analysis,and Spearman correlation analysis was used to test the correlation between body weight after dialysis,blood flow rate(BFR),and weight-normalized BFR.Results A total of 224 patients were enrolled in this study.Their average age was 58.2±13.3 years,and the male to female ratio was 5.2:1.The prescribed spKt/V was 1.39±0.29,and the measured spKt/V was 1.06±0.11.In the 117(52.2%)patients whose prescribed Kt/V was<1.4,the KoA of dialyzer(t=-8.619,P<0.001),BFR(t=-3.846,P<0.001)and weight-normalized BFR(t=-12.577,P<0.001)were significantly lower than those in spKt/V≥1.4 group.In the 224 patients,weight-normalized BFR decreased gradually with the increase of body weight(ρ=-0.666,P<0.001).There were 42 patients(18.8%)whose dialysis time was less than 240min,and 35 patients(15.6%)with blood coagulation in dialyzer.Residual native kidney function was present in 87 patients(38.84%);14 of the 87 patients were tested for residual renal function,of which 5 patients fulfilled the standard Kt/V after combination of the Kt/V values from residual renal function and dialysis.Conclusion Insufficient dialysis in hemodialysis patients may relate to the lower prescribed Kt/V,lower weight-normalized BFR,shorter dialysis time,blood coagulation in dialyzer,unreasonable calculation methods for dialysis adequacy,and acute complications during hemodialysis sessions.