UREA KINETICS AND WHEN TO COMMENCE DIALYSIS
UREA KINETICS AND WHEN TO COMMENCE DIALYSIS
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DOI：
10.1159/000168850
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发表时间：
1995-07-01
影响因子：
4.2
通讯作者：
FARRINGTON, K
中科院分区：
文献类型：
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作者：
TATTERSALL, J;GREENWOOD, R;FARRINGTON, K
血尿素和血清肌酐水平是决定何时开始透析的重要因素。最近，在评估透析充分性时，重点已从依赖这些参数转移到使用动力学方法。因此，我们应用尿素动力学模型（UKM）的63个连续的慢性肾功能衰竭（CRF）患者在透析开始的时间，并比较结果后6个月的透析治疗。透析开始时的平均标准化尿素清除率（每日KT/V）（KTi/V）为0.15 +/- 0.05，这是定期透析患者透析不足的指标。6个月后，随后接受CAPD的患者的平均每日KT/V为0.35 +/- 0.12，随后接受血液透析的患者为0.49 +/- 0.08（与平均KTi/V相比，p均< 0.001）。开始透析时的血清肌酐水平与任一模式治疗6个月后的血清肌酐水平相似。在平均随访10 +/-4.5个月期间死亡的6名患者的平均年龄（p < 0.01）和共病指数（p <0.05）高于存活者，平均KTiN低于存活者（p <0.05）。随访期间的住院率（不包括入路手术和培训的住院率）与年龄（r = 0.332，p < 0.01）、共病指数（r = 0.351，p < 0.01）和KTiN（r =-0.302，p < 0.05）相关。开始透析时的血尿素和血清肌酐水平在死亡者和幸存者中是相同的，与住院率无关。糖尿病患者开始透析时的平均KTi/V与非糖尿病患者相似，但平均血清肌酐较低（p < 0.005）。UKM可能有助于确定开始透析的最佳时间，特别是在糖尿病患者中，并且在许多患者中可能导致早期治疗。
Blood urea and serum creatinine levels are important factors in deciding when to start dialysis. Recently, in the assessment of dialysis adequacy, emphasis has shifted from reliance on these parameters to use of kinetic methods. We therefore applied urea kinetic modelling (UKM) to 63 consecutive chronic renal failure (CRF) patients at the time dialysis commenced and compared the results to those obtained after 6 months of dialysis treatment. Mean normalised urea clearance (daily KT/V) at the commencement of dialysis (KTi/V) was 0.15 +/- 0.05, a level indicative of underdialysis in regularly dialysed patients. After 6 months, mean daily KT/V was 0.35 +/- 0.12 in patients subsequently established on CAPD, and 0.49 +/- 0.08 in those subsequently haemodialysed (both p < 0.001 compared to mean KTi/V). Serum creatinine levels on commencing dialysis were similar to those after 6 months treatment by either mode. Mean age (p < 0.01) and co-morbidity index (p < 0.05) were higher, and mean KTiN lower (p < 0.05) in the 6 patients who died during a mean follow-up period of 10 +/- 4.5 months than in survivors. Hospitalisation rates during follow-up (excluding admissions for access surgery and training) correlated with age (r = 0.332, p < 0.01), co-morbidity index (r = 0.351, p < 0.01) and KTiN (r = -0.302, p < 0.05). Blood urea and serum creatinine levels on commencing dialysis were the same in those who died and in survivors and did not correlate with hospitalisation rates. Diabetics started dialysis with a similar mean KTi/V to non-diabetics but with a Lower mean serum creatinine (p < 0.005). UKM may help to define the optimum time to start dialysis, especially in diabetics, and in many patients may result in earlier treatment.