透析品質充分性指標Kt/V的線上測定及評估

The application of online urea clearance monitoring(OCM)in hemodialysis

目的探討在線尿素清除率監測(Online Clearance Monitoring,OCM)在血液透析中的應用價值,評估監測血液透析Kt/V的可行性及準確性。方法利用德國B.Braun公司Dialog透析機OCM檢測血液透析患者的Kt/V值(online Kt/V);同時抽血檢測血液透析患者前後尿素氮濃度,根據Daugirdas公式計算Kt/V值(eKt/V)作爲對照,比較兩種方法的相關性,以及不同體重、超濾量及透析時間對Kt/V值的影響。結果本組293例維持性血液透析患者利用OCM檢測的online Kt/V值(1.82±1.27)高於常規抽血方法所得的eKt/V值(1.69±0.37),相關性分析顯示:兩者存在顯著的直線相關性(r=0.765,p<0.001)。不同體重≧60Kg及<60Kg的兩組患者中,體重大的一組,Kt/V數值較大:online Kt/V 1.93±1.32 VS 1.59±1.14;eKt/V 1.79±0.36 VS 1.47±0.26,(p<0.001)。同樣,本組資料中,不同超濾量≧3Kg及<3Kg的兩組資料中,超濾量大的一組Kt/V數值較大:online Kt/V1.85±1.30 VS 1.74±1.12;eKt/V 1.73±0.35 VS 1.61±0.30.(p<0.001)。在本研究中,透析時間長短對Kt/V值無顯著差別。結論對維持性血液透析患者OCM和常規方法所得的Kt/V值相關性較好,而且這種方法操作簡便,能保證患者透析的充分性,OCM檢測值稍高於Kt/V,臨床上應注意兩者的差別。

Objective To investigate the feasibility and accuracy of online clearance mornitoring(OCM)in assessing Kt/V value of hemodialysis adequacy by a auto-control study during hemodialysis.Methods Kt/V values of 293 patients with maintenance hemodialysis were assessed by OCM appliance on Dialog machine.Meanwhile,blood urea nitrogen(BUN)of pre-and post-dialysis were examined,and caculated the Kt/V value according to the Daugirdas formula,then evaluated the correlation between Kt/V by OCM and by calculation.Kt/V by OCM and by calculation were also compared in different body weight,ultrafitration volume,and time respectively.Results The value of Kt/V by OCM(1.82±1.27)was higher than the value of Kt/V by calculation(1.69±0.37)and correlation between Kt/V by OCM and by calculation was satisfactory(r=0.765,p<0.001).The value of Kt/V of the group with more body weight and more ultrafitration volume were higher than the other group(online Kt/V 1.93±1.32 VS 1.59±1.14;eKt/V 1.79±0.36 VS 1.47±0.26,p<0.001);(online Kt/V 1.85±1.30 VS 1.74±1.12;eKt/V 1.73±0.35 VS 1.61±0.30,p<0.001).However,there was no significant difference in Kt/V between the two groups with different dialysis time.Conclusion Correlation between Kt/V by OCM and by calculation was satisfactory.The operation of OCM was convenient and can guarantee hemodialysis adequacy.Kt/V values by OCM are usually higher than those calculated by calculation from urea measurements.This difference has to be considered in application of the results to clinical practice.