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将残余肾功能纳入间歇血液透析的剂量计算

Authors
Anthony Bleyer, MD, MS
Thomas A Golper, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
赵新菊, 副主任医师

引言

大多数新发终末期肾病(end-stage renal disease, ESRD)的患者在开始血液透析时仍保留有一定程度的自体肾功能。对于有明显残余肾功能的特定患者，部分临床专家主张，在某些情况下血液透析剂量可根据自体肾功能提供的清除作用进行调整。对于这类患者，清除目标(即Kt/V)为血液透析和自体肾功能的清除之和[1-3]。因此，其血液透析剂量会低于常规处方的剂量。这种根据残余肾功能清除作用而开具较低血液透析剂量的方法被称为递增式血液透析[4]。

通过减少透析时间(如，每次治疗时间或治疗次数)或改变操作条件(如，透析器的大小和类型、透析液流速或血流速)，可减少开具的血液透析量。随着残余肾功能下降，透析剂量必须随时间推移而增加，以避免尿毒症。

本专题将提供给予递增式血液透析的方法，包括根据残余肾功能清除作用来估算透析剂量的方法。

标准透析剂量的计算将在别处讨论。 (参见“开具血液透析处方和评估血液透析的充分性”)

递增式腹膜透析也将在别处讨论。 (参见“腹膜透析的充分性”)

        

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-16.
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