尿素反跳对血液透析充分性参数评价的影响

The effect Of post-dialysis urea rebound on the parametric evaluation of hamodialysis adequacy

目的观察血液透析后尿素反跳(PDUR)对透析充分性评价的影响。方法 对27例维持性血液透析患者。根据其透析结束和结束后1h的尿素浓度。测算其PDUR以及两时点的尿素动力学参数(Kt/V.TACurea,PCR)并比较研究。结果PDUR为(17.81±5.94)％。尿素反跳后的Kt/V和PCR值较反跳前的值分别减少18.7％和12.7％(P<0.001),而TACurea值却增高3.1％(P<0.001).反跳前、后位于透析充分和不充分区的病例数存在较大差异,PDUR与透析间期尿量呈显著负相关(r=-0.64)。结论 透析后存在不同程度尿素反跳。忽略尿素反跳将错误估算参数值尤为Kt/V和PCR,以致误判透析的充分性。残存肾功能影响尿素反跳程度。

Objective To observe the effect of the post-dialysis urea rebound on evaluation of hernodialysis adequacy. Methods To calculate the extent of PDUR, and to compare urea kinetic modeling including Kt/V, TACurea and PCR with that after urea rebound, blood urea of 27 chronic hernodialysis patients with ESRD were obtained at the immediate post- and 60-minute post-dialysis. Results The mean PDUR was (17.81 ± 5.94)%, and made Kt/V and PCR decrease by 18.7%, 12. 7% respectively, but TACurea increase by 3. 1% ( P < 0. 001). The number of case situated in the adequate area or in the inadequate area before urea rebound had significant difference with that after urea rebound. Conclusions There is urea rebound of the different degree in postdialysis, which is affected usually by the residual renal functioa If PDUR is neglected, parameters, particularly Kt/V and PCR, may be calculated incorrectly so as to misestimate hemodialysis adequacy.