Kt评估维持性血液透析患者透析充分性的研究

Use of Kt instead of Kt/V as a marker of dialysis dose

目的探讨应用Kt评估透析充分性的优势。方法收集2017年1月～2017年7月于北京同仁医院血液净化中心行血液透析患者资料。根据体表面积(body surface area,BSA)计算目标透析剂量Kt[1/(0.0237/BSA(cm)+0.006)];根据Watson、HW、Chertow公式计算人体尿素分布容积V值及实际Kt值。应用ROC曲线分析Kt与Kt/V、URR一致性;根据Kt/V及Kt达标情况分组,采用SPSS 22.0软件进行统计学分析。结果共纳入103例患者,其中男65例,女38例。计算所得Kt值与Kt/V(AUC分别为0.826,0.797,0.700;P值分别为<0.001,<0.001,P=0.001)、URR(AUC分别为0.881,0.734,0.724;P值均<0.001)进行一致性检验,其中Watson法ROC分析曲线下面积最大。Kt/V达标率69%,Kt达标率44.7%。与均达标患者相比,Kt不达标但Kt/V达标患者在体质量(Z=-2.658,P=0.008)、BSA(Z=-2.822,P=0,005)、性别(χ~2=4.4543,P=0.035)、插管比例(χ~2=4.612,P=0.032)方面存在统计学差异。结论应用Kt作为衡量透析充分性的指标,可筛选出部分Kt/V达标但Kt不达标患者。该部分患者尤其见于男性、体质量较大、BSA较大、应用深静脉插管。联合应用Kt及Kt/V可更全面的评估血液透析患者透析充分性。

Objective The aim of this study was to compare the advantage of Kt versus Kt/V as a marker for dialysis dose. Methods We recruited the data of maintenance hemodialysis patients treated in the Dialysis Center of Tong Ren Hospital from January 2017 to July 2017. Target Kt was calculated by the formula of:target Kt =1/[0.0069 +(0.0237/BSA(cm)], where BSA is the abbreviation of body surface area. V value was calculated by Watson, HW and Chertow formulas. Receiver Operating Characteristic(ROC) curve was used to analyze the consistency of Kt with Kt/V and URR. SPSS v.22 was used to conduct the analyses. Results In the 103 patients, 65 were males and 38 were females. ROC curve was used for the consistency of Kt with Kt/V(AUC 0.826, 0.797 and 0.700;P<0.001, P<0.001 and P=0.001) and URR(AUC 0.881, 0.734, 0.724;P<0.001). The AUC of Watson method for both Kt/V and URR was the biggest. In the 103 patients, 69% reached the Kt/V but only 44.7% reached the Kt. There were significant differences in body weight(Z=-2.658, P=0.008), BSA(Z=-2.822, P=0,005), sex(χ~2=4.4543, P=0.035), indwelling catheterization(χ~2=4.612, P=0.032)between the patients who reached both Kt/V and Kt and the patients who reached Kt/V but not Kt. Conclusions The advantage of monitoring Kt instead of Kt/V is the identification of the patients who did not reach the minimum Kt but satisfied Kt/V value, especially in those with heavier body weight, larger BSA, male sex and catheters in deep vein.