维持性血液透析患者的血压与透析充分性及相关因素分析

目的观察维持性血液透析(MHD)患者血压与透析充分性及其它相关因素间的关系。方法 56例MHD连续12次记录透析前后血压、体重、超滤量(FV),分别计算收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)的均值,第0、1、2、3个月透析前后测定血液生化值、甲状旁腺激素(PTH)、血红蛋白(Hb)、红细胞压积(Hct),计算尿素清除指数(Kt/V)、尿素下降率(URR)。结果透析充分组(Kt/V≥1.2、URR≥0.65)MHD患者血压明显低于透析不充分组(Kt/V<1.2、URR<0.65)差异有统计学意义(P<0.05);Hct≥0.22组与Hct<0.22组比较MAP差异有统计学意义(P<0.05);Logistic回归分析显示透析间期体重增加量、体重增加率、透析不充分及血清PTH水平与透析前收缩压密切相关(OR=1.98~3.50,P<0.05)。结论充分透析、减少容量负荷是控制MHD患者高血压的关键,透析不充分、透析间期体重增长过多、高血清甲状旁腺激素水平与透析前收缩压升高有密切关系。     

Multivariate analysis of urea clearance index in maintenance hemodialysis patients from a single center

目的 计算维持血液透析患者的单次尿素清除指数(Kt/V),记录透析过程中的血流量、超滤量、血红蛋白和体重指数( BMI)等指标,并分析这些指标对Kt/V的影响.方法 选取我院血液净化中心维持血液透析3个月以上的终末期肾病患者135例,计算每个患者该次血液透析的Kt/V,Kt/V≥1.2为Kt/V达标组,Kt/V＜ 1.2为Kt/V不达标组,统计分析Kt/V与血流量、超滤量、血红蛋白、体重指数等指标的相关性.结果 135例患者中,血流量(β=0.052)和超滤量(β=1.143)与单次血液透析的Kt/V呈正相关(P＜0.05),BMI(β=-0.404)和血红蛋白(β=-0.063)与单次血液透析的Kt/V呈负相关(P＜0.05).结论 血流量、BMI、超滤量和血红蛋白是单次血液透析Kt/V的重要影响因素.     

夜间血液透析病人不使用任何磷结合剂控制血浆磷

高磷血症是慢性肾衰竭病人的早期表现之一，它在继发性甲状旁腺分泌亢进症的发生中起重要作用。尽管预防和治疗高磷血症的方法很多，但都不尽人意。本研究的目的是评价夜间血液透析（NHD）——一种新的透析模式对终末期肾衰竭病人血浆磷的清除及其长期效果。方法短期研究：目的是比较NHD和CHD（常规血透）对磷清除的效果及透析过程中和透析后血浆磷水平即时变化的动力学。8例病人采用自身对照的方法，先CHD4周，每周透析3次，每次透析4小时，透析器为FreseniusF80，血流量300～500ml／min，透析液流量500ml／min，透析液成分（mmol／L…     

维持性血液透析患者营养状况评估及影响因素分析

目的 评估维持性血液透析（MHD）患者的营养状况并分析影响因素,为改善患者预后提供指导.方法 选择同期行MHD的患者113例,分别采用主观综合营养评价法（SGA）、人体学指标及生化指标测定评估营养状况,同时根据单次透析前后尿素氮（BUN）计算透析充分性指标尿素清除指数（Kt/V）、尿素减少率（URR）,比较SGA营养良好与不良者相关指标.结果 SGA评价营养良好49例（43.36%）、轻中度营养不良57例（50.44%）、重度营养不良7例（6.2%）、营养不良发生率为56.64%,人体学指标及生化指标评估营养不良发生率为19.5%～92.0%;透析3次/周者Kt/V显著高于2次/周及5次/2周者（P均〈0.05）;SGA营养不良者上臂肌围（MAMC）、前白蛋白（PA）及透析前肌酐显著低于营养良好者（P均〈0.05）.结论 MHD患者PEM发生率高,血清PA、MAMC及透析前血清Cr水平与患者营养状况有关,可作为评估的可靠、敏感指标;保证透析充分性,增加蛋白质、热量摄入,纠正代谢性酸中毒及应用EPO等药物有望改善预后.     

高血流量与高透析液流量透析对维持性血液透析患者微炎症状态及营养状况的影响

目的探讨高血流量及高透析液流量透析对维持性血液透析患者微炎症状态以及营养状况的影响。方法选取2014年6～12月在我院血液净化中心进行维持性血液透析的患者80例为研究对象,采用随机数表法分为两组,每组40例。对照组患者给予常规血流量、常规透析液流量透析治疗,设定血流量为250～300 m L/min,透析液流量为500 m L/min;观察组患者给予高血流量、高透析液流量透析治疗,设定血流量为300～350 m L/min,透析液流量为800 m L/min。比较两组患者的微炎症状态及营养状况。结果治疗1个月和6个月后,两组患者TNF-α、IL-6、hs-CRP水平均显著下降,观察组的TNF-α、IL-6、hs-CRP水平均显著低于对照组,差异有统计学意义(P 0. 05);两组患者血清白蛋白(ALB)、总蛋白(TP)、血红蛋白(Hb)水平均显著上升,观察组患者ALB、TP、Hb水平均显著高于对照组,差异有统计学意义(P 0. 05)。结论高血流量与高透析液流量透析治疗能更有效地改善维持性血液透析患者的微炎症状态及营养状况,提高临床治疗效果。     

应用尿素动力学模型评价血透患者透析充分性和营养状态的临床研究

应用尿素动力学参数时间平均尿素浓度（TACurea）、整体尿素清除率（KT／V）、蛋白质分解代谢率（PCR），对42例维持性血液透析患者透析充分性及营养状态进行评价，并与临床结果进行比较，发现TACurea和PCR是反映血液透析长期充分与否的重要指标．KT／V可直接反映单次透析效果，是调整透析方案的最佳指标．在透析不充分的情况下，KT／V对PCR有着重要影响．     

无糖碳酸盐血液透析21例临床观察

2001年8月至2002年3月,我院采用无糖碳酸氢盐透析粉配制透析液,对21例急慢性肾功衰竭及中毒患者进行了608次血液透析治疗,疗效满意。现报告如下。 临床资料:21例患者中男13例、女8例,年龄19～70岁,其中中毒1例,急性肾功能衰竭4例,慢性肾功能衰竭16例。 治疗方法:采用日本产JMS SDS-20型血液透析机,TF-111碳酸盐透析粉无糖,1480C透析器;透析液流量为500ml/min,血流量为200～260ml/min;透析液温度36.5～37℃,透析时间2～5h/次,1～3次/周、肝素首量10～25mg,维持量2.5～7.5mg/h。对于有出血倾向的患者,根据病情给予小剂量肝素、微量肝素或无肝素透析。     

尿素监测仪与常规取血方法检测血透患者KT／V的比较

本文用尿素监测仪评价了４２例透析患者的尿素清除指数（ＫＴ／Ｖ），并同常规取血方法比较，对尿素监测仪在评价透析充分性方面的临床意义做初步的探讨。１对象和方法随机选我院透析稳定的血透患者４２例，其中男１９例，女２３例，透析时间１～９年，透析中血流量２００...     

维持性透析患者体内的炎症状态

70年代起，随着对透析充分性认识的提高，人们将其定义为小分子溶质的清除(如尿素清除率Kt／V)，并相信它对提高终末期肾衰(ESRF)患者生存率起着非常重要的作用。因而在随后的20年中，透析剂量逐步上升。事实上，在那些处于较高溶质清除水平的患者，即使再增加透析剂量，     

腹膜透析净超滤量对慢性肾衰竭患者残余肾功能的影响

将100例行腹膜透析（腹透）治疗〉1a的尿毒症患者按透析净超滤量〈500、500～1000、〉1000ml／d分为Ⅰ、Ⅱ、Ⅲ组。对三组腹透前和透析1a时每日尿量进行比较分析。结果Ⅰ组尿量较腹透前减少14％,Ⅱ组减少34％,Ⅲ组减少67％。证实随每日腹透净超滤量的增加。残余尿量降低速率增加。认为有严重水潴留的尿毒症患者可短时使用高渗透析液,将每日净超滤量控制在1000ml左右;无明显水潴留时每日腹透净超滤量应控制在500ml左右。     

Monitoring hemodialysis dose with ionic dialisance in on-line hemodiafiltration

Until now, with the ionic dialysance measurement, it has been possible to determine hemodialysis dose in each session of hemodialysis (HD) and in the conventional hemofiltration (HDF) but not in the modality of on-line HDF. Recently it is possible with a new biosensor that allows to measure the dose in on-line HDF. The aim of this study was to evaluate the value of this biosensor in different dialysis situations comparing the dialysis dose measured in blood in comparison with the values obtained from the sensor. We have analysed 192 hemodialysis sessions performed in 24 patients, 15 male and 9 female, mean age of 70.2 +/- 12 years, included in on-line HDF. All treatments were done using 4008H (Fresenius) monitor equipped with on-line clearance monitoring (OCM), that measure, with non invasive monitoring, the effective ionic dialysance equivalent to urea clearance. Every patient received eight dialysis sessions: one with dialysate flow (Qd) 500 ml/min, two with HD and Qd 800 ml/min and five with on-line HDF. Other habitual haemodialysis parameters were no changed, dialysis time 200 +/- 63 min (135-300) and blood flow 421 +/- 29 ml/min (350-450). Initial and final ionic dialysance values (K), final Kt, Kt/V measured with OCM using V of Watson, and Kt/V determined in blood pre and postdialysis concentrations of urea (Daugirdas second generation), were measured. The mean of initial K was 251 +/- 21 ml/min and the final K was 234 +/- 24 ml/min. The Kt measured with OCM was 50.6 +/- 17 L, 51.2 +/- 17 in men and 49.7 +/- 16 in women. The V (Watson) was 34.5 +/- 6 L. The Kt/V measured with the Kt of OCM and V was 1,499 +/- 0.54 and Kt/V measured in blood samples was 1,742 +/- 0.58. The correlation between both values was 0.956. The Kt was different according to dialysis modality used: in HD and Qd 500 was 44.7 +/- 15 L, in HD and Qd 800 was 50.7 +/- 17 and in on-line HDF (22.1 +/- 7 L of reposition volume), was 51.8 +/- 17 L. The Kt/V from blood samples also shows variation: in HD and QD 500 was 1.60 +/- 0.55, in HD and Qd 800 was 1,726 +/- 0.56 and in on-line HDF was 1,776 +/- 0.59. In this study has been observed a close correlation between the new biosensor OCM with the measures obtained from the blood samples. For this reason this sensor it is useful in all modalities of dialysis treatment, included on-line HDF. The sensor was able to discriminate the efficacy of different dialysis modalities used in this study.     

老年维持性血液透析患者炎症氧化应激状态与贫血的关系

目的 评价老年维持性血液透析（MHD）患者炎症、氧化应激与贫血的关系.方法 选取2013年3月在我院治疗的MHD患者79例,其中包括年龄≥65岁老年患者48例及＜65岁的非老年MHD患者31例,透析龄均超过3个月,透析当日上机前空腹采血测定血红蛋白（Hb）、甲状旁腺激素（I-PTH）、高敏C反应蛋白（hs-CRP）、丙二醛（MDA）、超氧化物歧化酶（SOD）、血清白蛋白（Alb）水平及透析前后血尿素氮（BUN）,并根据透析时间、脱水量、干体重计算KT/V及尿素氮清除率（URR）,同时记录每周促红细胞生成素（EPO）、铁剂用量、透析时间.结果 老年组MHD患者贫血达标率为45.8％,明显低于非老年组的70.9％,维持相同血红蛋白水平需要皮下注射更大剂量重组人促红细胞生成素剂量（rHuEPO）（P＜0.05）;老年组MHD患者hs-CRP、MDA明显升高,SOD、Alb明显降低（P＜0.05）;老年贫血患者hs-CRP、MDA明显升高,SOD、Alb明显降低（P＜0.05）.结论 老年患者贫血达标率低,氧化应激状态是其贫血发生的主要原因,hs-CRP、SOD、MDA、Alb是反映老年MHD患者氧化应激的敏感指标.     

Kt as control and follow-up of the dose at a hemodialysis unit

To ensure our patients are receiving an adequate dose in every dialysis session there must be a target to achieve this in the short or medium term. The incorporation during the last years of the ionic dialysance (ID) in the monitors, has provided monitoring of the dialysis dose in real time and in every dialysis session. Lowrie y cols., recommend monitoring the dose with Kt, recommending at least 40 L in women and 45 L in men or individualizing the dose according to the body surface area. The target of this study was to monitor the dose with Kt in every dialysis session for 3 months, and to compare it with the monthly blood test. 51 patients (58% of our hemodialysis unit), 32 men and 19 women, 60.7+/-14 years old, in the hemodialysis programme for 37.7+/-52 months, were dialysed with a monitor with IC. The etiology of their chronic renal failure was: 3 tubulo-interstitial nephropathy, 9 glomerulonephritis, 12 vascular disease, 7 polycystic kidney disease, 7 diabetic nephropathy and 13 unknown. 1,606 sessions were analysed during a 3 month period. Every patient was treated with the usual parameters of dialysis with 2.1 m2 cellulose diacetate (33.3%), 1.9 m2 polisulfone (33.3%) or 1.8 m2 helixone, dialysis time of 263+/-32 minutes, blood flow of 405+/-66, with dialysate flow of 712+/-138 and body weight of 66.7+/-14 kg. Initial ID, final ID and Kt were measured in each session. URR and Kt/V were obtained by means of a monthly blood test. The initial ID was 232+/-41 ml/min, the final ID was 197+/-44 ml/min, the mean of Kt determinations was 56.6+/-14 L, the mean of Kt/V was 1.98+/-0.5 and the mean of URR was 79.2+/-7%. Although all patients were treated with a minimum recommended dose of Kt/V and URR when we used the Kt according to gender, we observed that 31% of patients do not get the minimum dose prescribed (48.1+/-2.4 L), 34.4% of the men and 26.3% of the women. If we use the Kt individualized for the body surface area, we observe that 43.1% of the patients do not get the minimum dose prescribed with 4.6+/-3.4 L less than the dose prescribed. We conclude that the monitoring of dialysis dose with the Kt provides a better discrimination detecting that between 30 and 40% of the patients perhaps do not get an adequate dose for their gender or body surface area.     

Evaluation of methods to calculate dialysis dose in daily hemodialysis

Daily dialysis has shown excellent clinical results because a higher frequency of dialysis is more physiological. Different methods have been described to calculate dialysis dose which take into consideration change in frequency. The aim of this study was to calculate all dialysis dose possibilities and evaluate the better and practical options. Eight patients, 6 males and 2 females, on standard 4 to 5 hours thrice weekly on-line hemodiafiltration (S-OL-HDF) were switched to daily on-line hemodiafiltration (D-OL-HDF) 2 to 2.5 hours six times per week. Dialysis parameters were identical during both periods and only frequency and dialysis time of each session were changed. Time average concentration (TAC), time average deviation (TAD), normalized protein catabolic rate (nPCR), Kt/V, equilibrated Kt/V (eKt/V), equivalent renal urea clearance (EKR), standard Kt/V (stdKt/V), urea reduction ratio (URR), hemodialysis product and time off dialysis were measured. Daily on-line hemodiafiltration was well accepted and tolerated. Patients maintained the same TAC although TAD decreased from 9.7 +/- 2 in baseline to a 6.2 +/- 2 mg/dl after six months, p < 0.01. No significant changes were observed in weekly Kt/V and eKt/V throughout the study. However EKR, stdKt/V and weekly URR were increased during D-OL-HDF in 24-34%, 46% and 50%, respectively. Hemodialysis product was raised in a 95% and time off dialysis was reduced to half. CONCLUSION: Dialysis frequency is an important urea kinetic parameter which there are to take in consideration. It's necessary to use EKR, stdKt/V or weekly URR to calculate dialysis dose for an adequate comparison between different frequency dialysis schedules.     

残余肾功能状态对腹膜透析效能的影响

目的:前瞻性观察终末期肾衰(ESRF)患者在腹膜透析(PD)治疗后残余肾功能(RRF)对透析效能及相关临床指标之间的影响。方法:所有患者按残余肾小球滤过率(rGFR)水平将其分为A组(GFR0~2ml/min)、B组(GFR2·1~4ml/min)和C组(GFR>4ml/min)。每3个月进行一次临床随访,全面评估患者的全身情况及透析状态,包括血压、身高、体重、体重指数(BMI)、尿量(UV)、残余肾肌酐清除率(Ccr)、每周总尿素氮表现率(Kt/Vtotal)、每周肌酐总清除率(WCcrtotal)、蛋白氮呈现率(nPNA)、残余肾尿素及Ccr。对比观察不同RRF状态患者透析状况和部分临床及生化指标变化。尿量<100ml/d或Ccr<1·0ml/min视为无尿。结果:三组不同残肾状态患者Kt/vtotal和Ccr分别为1·75±0·35、2·07±0·54、2·46±0·50和53·4±11·2、66·6±11·2、97·6±22·1(L/Wks),各组之间差异非常显著(P<0·001)。三组不同残余肾Kt/v和Ccr分别占总体kt/v的12·4%、27%、45·7%及总体Ccr的18·3%、47·3%和65·3%,三组间相比差异亦显著(P<0·01)。此外,三组间高血压发生率、心胸比例及左心室肥厚(LVH)亦存在一定差异,C组心脏增大的病例明显低于A、B两组。RRF状态与透析效能呈正相关。本组患者除2例在透析治疗时即无尿,128例患者中有31例(24·2%)发生无尿,其中原发病为血管炎综合征及糖尿病肾病各占4例和7例,其无尿发生率分别占本病种的66·7%及25·9%;另20例无尿患者为肾小球肾炎或其它疾病,占此类疾病的20·6%。此外,发生无尿患者中有5例(16·1%)透析时尿量<300ml/d。结论:PD患者的残余肾仍然是清除体内代谢产物的重要途径,同时也影响血压及心血管系统并发症。     

川芎嗪联合非洛地平可增强维持性血液透析患者抗氧化应激能力

目的：探讨川芎嗪联合非洛地平对维持性血液透析（MHD）患者抗氧化应激能力及残余肾功能（RRF）的影响。方法：选取2018年4月至2020年6月淮南新华医疗集团新华医院血液透析中心采取相同透析方案的70例MHD患者，随机分为对照组和观察组，每组35例。2组患者均给予常规血液透析、非洛地平降压等基础治疗，观察组在基础治疗上加用川芎嗪注射液治疗，40mg/次，3次/周，于透析治疗结束后静脉滴注。比较2组患者治疗前及治疗6个月后尿量、RRF、血液透析充分性 [尿素下降率（URR）、尿素清除指数（KT/V）]、外周血超氧化物歧化酶（SOD）、丙二醛（MDA）及生活质量 [生理健康总测量（PCS）、心理健康总测量（MCS）]评分变化及不良反应发生情况。结果：治疗后，2组患者尿量、RRF均较治疗前下降，且观察组高于对照组（P均<0.05）。观察组URR、KT/V较治疗前显著提高，且治疗后明显高于对照组（P均<0.05）。2组患者SOD水平较治疗前升高，且观察组高于对照组（P均<0.05）；MDA水平较治疗前降低，且观察组低于对照组（P均<0.05）。治疗后，2组患者PCS、MCS评分较干预前降低，且观察组PCS、MCS评分高于对照组（P均<0.05）；2组治疗期间均未见明显的药物不良反应。结论：川芎嗪联合非洛地平可增强MHD患者的抗氧化应激能力，延缓其RRF的下降，提高血液透析充分性及生存质量，且安全性较好。     

The role of hematocrit in efficiency of dialysis

To test the role of hematocrit (Hct), particularly when in the nearly normal range, on efficiency of dialysis, we analyzed the urea kinetics for 36 metabolically and hematologically stable patients on regular dialysis treatment and for 7 patients from this group before and after 3 months of treatment with human recombinant erythropoietin (rHuEPO). The volume of distribution of urea (V), the dialyzer clearance (Kd) and Kt/V were plotted against Hct. Hct showed a significant inverse correlation with Kd (r = 0.479, p = 0.003) and Kt/V (r = 0.572, p = 0.0002). Further division of the patients into groups with respect to Hct showed that the lowest Kt/V values were in the group with Hct greater than or equal to 37%. In the patients treated with rHuEPO, Hct rose from 18 +/- 1 to 35 +/- 5% (p less than 0.0001), and Kt/V decreased from 1.22 +/- 0.21 to 1.09 +/- 0.18 (p = 0.037). We conclude that Hct exerts a negative influence on efficiency of dialysis as evaluated by Kt/V. This is important for patients with normal or nearly normal Hct levels as well as for patients treated with rHuEPO, for whom normalization of Hct is pursued.     

Evaluation of pre- and postdilutional on-line hemodiafiltration adequacy by partial dialysate quantification and on-line urea monitor.

On-line highflux hemodiafiltration (HDF) is a clinically interesting and effective mode of renal replacement therapy, which offers the possibility to obtain an increased removal of both small and large solutes. The fundamental role of urea kinetic monitoring to assess dialysis adequacy in conventional hemodialysis has been widely studied. Both direct measurement of the urea removed by the modified direct dialysate quantitation (mDDQ) based on partial dialysate collection (PDC) and dialysate-based urea kinetic modeling (DUKM) using urea monitor have been advocated. The validity of this assessment tool in the patients with on-line HDF remained unclear. The aims of this investigation were (1) to compare the delivered Kt/V, urea mass removal (UMR), solute removal index (SRI) and normalized protein catabolic rate (nPCR) between pre- and postdilutional high-flux HDF; (2) to verify and compare the efficiency of pre- and postdilutional HDF using DUKM with on-line dialysate urea sensor, and mDDQ with partial dialysate collection. During both mode of HDF, the paired analysis urea removed and Kt/V showed no significant difference. Using mDDQ, mean values for predilutional mode were as follows: Kt/V 1.53 +/- 0.01 UMR, 16.8 +/- 0.3 g/session; urea clearance 178 +/- 18 ml/min; SRI 75.5 +/- 7.7%; urea distribution volume (V) 28.3 +/- 1.2 liters; nPCR 1.34 +/- 0.18 g/kg/day; on the other hand, mean values for postdilutional mode were Kt/V 1.58 +/- 0.01; UMR 17.10 +/- 0.28 g/session; urea clearance 184 +/- 21 ml/min; SRI 77.2 +/- 3.5%; urea distribution volume, 27.8 +/- 1.5 liters; nPCR 1.34 +/- 0.19 g/kg/day. The mean value of urea generation rate was 5.82 +/- 1.12 mg/min during HDF. Our results showed that dialysis adequacy was achieved with both high-volume predilutional HDF and postdilutional HDF. These two modes of HDF provided similar and adequate small solute clearance. In addition, we found that on-line analysis of urea kinetics is a reliable tool for quantifying and assuring delivery of adequate dialysis.