中通量透析与低通量透析对透析充分性的评估观察

仝旭珍沈万生+周红+吴敏+包雅各+占永标+葛永亮+胡惠莉

[摘要] 目的 通過观察中通量血液透析与低通量血液透析对慢性肾衰竭维持性透析患者尿素清除率（URR）及Kt/v值的变化，有效评估患者透析充分性。 方法 选取2012年3月～2016年3月维持性血液透析患者164例，观察组（n=114）：中通量透析组（B-16P聚砜膜），对照组（n=50）：低通量透析组（F7HPS聚砜膜），每周血液透析3次，每次4 h，疗程1年，随访6个月。监测患者每季度单次透析前后的肾功能变化，监测URR、Kt/v值，观察中通量透析与低通量透析方式对患者尿素氮、尿酸、肌酐清除效果。 结果 两组透析前尿素氮、尿酸、尿素氮、肌酐数值比较差异无统计学意义（P>0.05），透析后两组尿素氮、尿酸、肌酐值及尿素清除率URR、尿素氮Kt/v比较，差异有统计学意义（P<0.05）。 结论 在血液透析频次相同、成本相同的前提下，中通量血液透析对尿素、肌酐等小分子毒素清除效果优于低通量透析，透析充分性更佳，患者受益更多。

[关键词] 血液透析；小分子毒素；透析充分性；尿素清除率

[中图分类号] R692.5 [文献标识码] B [文章编号] 1673-9701（2017）34-0098-03

Evaluation of dialysis sufficiency by medium flux dialysis and low flux dialysis

TONG Xuzhen SHEN Wansheng ZHOU Hong WU Min BAO Yage ZHAN Yongbiao GE Yongliang HU Huili

Department of Nephrology， Zhejiang Xiaoshan Hospital， Hangzhou 311200， China

[Abstract] Objective To effectively evaluate the sufficiency of dialysis in patients by observing the effect of medium-flux hemodialysis and low-flux hemodialysis on the changes of URR and Kt/v in chronic renal failure patients with maintenance dialysis. Methods A total of 164 patients with maintenance hemodialysis from March 2012 to March 2016 were enrolled in this study. The observation group（n=114）： medium flux dialysis group（B-16P polysulfone membrane）. The control group（n=50）： low-flux dialysis group（F7HPS polysulfone membrane）. Hemodialysis was performed three times a week for 4 hours each time. The course of treatment was 1 year， and the patients were followed up for 6 months. The changes of renal function in patients before and after single dialysis in each quarter， URR and Kt/v were monitored. The effects of medium and low-flux dialysis on urea nitrogen， uric acid and creatinine clearance were observed. Results There was no significant difference in the values of urea nitrogen， uric acid， urea nitrogen and creatinine before dialysis between medium dialysis group and low-flux dialysis group （P>0.05）. After dialysis， there were significant differences in the levels of urea nitrogen， uric acid， creatinine， urea clearance rate URR and urea nitrogen Kt/v between the two groups（P<0.05）. Conclusion Under the premise of the same hemodialysis frequency and the same cost， the removal effect of small molecule toxins including medium flux hemodialysis on urea， creatinine is better than that of the low-flux dialysis. And the medium flux hemodialysis has better dialysis sufficiency， from which patients benefit more.

[Key words] Hemodialysis； Small molecule toxin； Dialysis sufficiency； Urea clearance rateendprint