Portable Hemodialysis Machine for Chronic Hemodialysis in Hospital—Advantages and Future Uses

Introduction: Nx stage one machine results can help to enhance the clinical efficiency and shortage concerning the use of home hemodialysis. Therefore, the study investigates effectiveness of Nx stage machine for intermittent conventional hemodialysis in hospital for inpatients and outpatients to replace conventional hemodialysis in stable chronic hemodialysis patients. Methods: Prospective observatory study was conducted in Nephrology Division, King Fahd General Hospital from April 1 to June 1 2018. Patients with ESRD, who were dependent on dialysis and maintained on regular hemodialysis were recruited. Fifty-two sessions of hemodialysis were performed. The patients were given intermittent dialysis using Nx stage one machine. Pre and Post dialysis investigations and body weight were taken, and patients were observed for any complications during or post-dialysis. Findings: The primary endpoint ultrafiltration with a goal to remove 1 - 4 kg was achieved without any technical difficulty. Secondary endpoint for potassium reduction levels was achieved with mean SD post-dialysis 3.53 ± 0.3, and the tertiary endpoint was achieved in a patient less than 50 kg weight with spKt/V above 1.2. It was difficult to achieve spKt/V in patients with weight more than 60 kg due to limitations in the duration of sessions or dialysate volume. Target spkT/V was achieved for patients with body weight less than 50 kg;however, it was not achieved among the patients with body weight more than 60 kg. Discussion: Nx stage one machine can replace conventional intermittent dialysis in terms of ultrafiltration and Potassium correction;however, further investigation is needed for urea clearance.

Adimea系统对维持性血液透析患者透析充分性的评价

目的:探讨Adimea系统在评价维持性血液透析患者透析充分性的应用价值。方法:检测上海交通大学医学院附属瑞金医院血液净化中心167例维持性血液透析患者通过采血法及Adimea系统监测获得的单室尿素清除指数(spKt/V),通过线性相关分析了解两者的相关性,通过多元线性回归分析了解Adimea系统监测尿素清除率的临床影响因素,并比较spKt/V值达标与未达标患者的临床资料。结果:(1)Adimea系统监测spKt/V(1.47±0.27),采血法spKt/V(1.47±0.26),直线相关分析显示,两者具有良好的相关性(r=0.697,P<0.001)。(2)干体重、前白蛋白、体重增长率、尿酸、透析前尿素氮是Adimea测定spKt/V值的独立影响因素,其中干体重(OR=0.587,P<0.001)、透前尿素氮(OR=0.855,P=0.015)为负相关,前白蛋白(OR=1.300,P<0.001)、体重增长率(OR=1.240,P=0.001)、尿酸(OR=1.206,P=0.003)为正相关。(3)spKt/V-Adimea达标组和未达标组在性别、尿素下降率(URR)、透前体重、干体重等方面存在显著差异,实验室指标无明显差异。结论:Adimea系统监测spKt/V值与采血法spKt/V值具有显著相关性,可应用于实时在线监测尿素清除指数,是临床评价透析充分性的可靠指标。

对透析充分性的认识更新

spKt/Vurea是指用第二代单室可变体积尿素动力学模型估计的尿素清除指数,它只能用来表示单次透析对小分子非蛋白结合毒素的清除是否充分。要表示这类毒素的清除是否充分,需要计算std Kt/Vurea。可以用增加透析次数的手段提高std Kt/Vurea,以改善患者长期存活。当前还没有评价蛋白结合溶质、中大分子溶质、在体液不均匀分布溶质的透析充分性,的公认方法。