维持性血液透析后血清尿素反弹及其影响因素研究

目的观察维持性血液透析患者透析后血清尿素反弹情况,并研究相关影响因素。方法选取稳定的维持性血液透析患者50例,取透析前、透析结束时、透析后15和30min的血样,定量观察尿素反弹及其对透析充分性指标单室尿素清除指数（spKt/V）和血清尿素下降率（URR）的影响,并分析其与患者人口学特征、透析参数的相关关系。结果血液透析后的血清尿素反弹平均达13.6%,导致URR和spKt/V分别高估0.04个百分点和0.14个单位。影响尿素反弹最重要的因素是透析效率K/V,此外还有较高的血红蛋白、较多的相对超滤量、动脉-静脉通路和男性。结论血液透析后的尿素反弹是普遍存在的现象,对于特定的个体和透析过程,其对充分性指标的影响不能忽略。

Post-hemodialytic urea rebound and its impact factors in Chinese maintenance dialysis patients

Objective To observe the urea rebound after hemodialysis in Chinese maintenance dialysis patients,and explore its impact factors.Methods In 50 stable the hemodialysis patients,blood samples were taken at the beginning,immediate post-dialysis,15 minutes and 30 minutes after ending of dialysis.The urea rebound was quantified,as well as its effect on URR and Kt/V.The impact factors on urea rebound were analyzed.Results In this group of patients,average post-dialytic urea rebound was 13.6%,leading to over-estimation of URR and Kt/V of 0.04 and 0.14,respectively.Hemodialysis efficiency expressed as K/V determined urea rebound most significantly.Other impact factors included higher hemoglobin,higher relative ultrafiltration,arterial-venous access,and male patients.Conclusion Urea rebound was common after the end of hemodialysis.For specific patients and hemodialysis sessions,ignoring it would lead to significant over-estimation of delivered hemodialysis dose.