中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (10): 744-748.doi: 10.3969/j.issn.1671-4091.2023.10.006

• 临床研究 • 上一篇    下一篇

尿素清除率K作为影响血液透析患者透析充分性重要指标的临床研究

张洪利   朱 强    廖永平   田 冲   高 宁   

  1. 62550 任丘，1华北石油管理局总医院肾病与风湿免疫科
  • 收稿日期:2023-05-18 修回日期:2023-07-25 出版日期:2023-10-12 发布日期:2023-09-28
  • 通讯作者: 张洪利 E-mail:pwc9236@163.com

Clinical study of urea clearance K as an important index affecting the adequacy of dialysis in hemodialysis patients

ZHANG Hong-li, ZHU Qiang, LIAO Yong-ping, TIAN Chong, GAO Ning   

  1. Department of Nephrology and Rheumatology Immunology, Huabei Petroleum Administration Bureau General Hospital,  Ren qiu 062550, China
  • Received:2023-05-18 Revised:2023-07-25 Online:2023-10-12 Published:2023-09-28
  • Contact: 062550 任丘，1华北石油管理局总医院肾病与风湿免疫科 E-mail:pwc9236@163.com

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摘要： 目的 通过联机清除率监测(online clearance monitoring，OCM)实时动态监测，探讨透析过程中尿素清除率(urea clearance，K)的变化规律、影响因素及与透析充分性之间的量化关系。 方法 应用OCM观察152例血液透析患者透析中不同时段的K值，采用重复测量方差分析探究透析过程中K变化规律；采用多元线性回归分析平均K值的影响因素；采用Pearson进行相关性分析。 结果 K随时间变化呈线性下降(F=447.552，P＜0.001)。血流量(β=0.706，95% CI：0.403～0.526,P＜0.001)、超滤系数(β=0.183，95% CI：0.074～0.223,P＜0.001)与K呈正相关，红细胞比容(HCT)(β=-0.242，95% CI：-0.877～
-0.405,P＜0.001)、年龄(β=-0.106,95% CI：-0.209～-0.011,P =0.030)与K呈负相关。K与3倍干体质量的差值和Kt/V之间存在显著相关性(r =0.808，P＜0.001)。 结论 透析过程中K呈线性缓慢下降。提高K的手段是增加血流量、使用高通量透析器，控制HCT在33%～36%。若透析充分性达标，K应大于干体质量的3倍。

关键词: 尿素清除率, 透析充分性, 联机清除率监测, 透析时间, 干体质量

Abstract: Objective  Through online clearance monitoring (OCM), the quantitative relationship among the changes of urea clearance (K), its influencing factors and dialysis adequacy during dialysis processes are discussed.  Methods   A total of 152 maintenance hemodialysis patients were investigated. The K value during a hemodialysis session was recorded by OCM every hour. ANOVA of repeated measurements was used to explore the rule of K change during hemodialysis. Multivariate linear regression was used to explore the influencing factors for average K value. Results  The K value decreased linearly with time during a hemodialysis session (F=447.552, P＜0.001 ). The K value was positively correlated with blood flow rate (BFR) (β=0.706, 95% CI：0.403～0.526, P＜0.001) and ultrafiltrate coefficient (β=0.183, 95% CI：0.074～0.223, P＜0.001), and was negatively correlated with haematocrit (HCT) (β=-0.242, 95% CI：-0.877～-0.405, P＜0.001) and age (β=-0.106, 95% CI：-0.209～-0.011, P=0.030). We also found that there was a significant correlation between the difference of K value and three times of dry body weight and the dialysis adequacy of Kt/V (Pearson correlation analysis, r=0.808, P＜0.001).  Conclusion   The K value decreases linearly and slowly during a hemodialysis session. The ways to increase K value include the increase of BFR, the use of high-flux dialyzer, and the maintenance of HCT within 33～36%. We infer that the K value should be more than three times of the dry body weight to obtain a standard level of dialysis adequacy.

Key words: Urea clearance, Dialysis sufficiency, Online clearance monitoring, Dialysis session length, Dry body weight

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