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开具血液透析处方和评估血液透析的充分性

Authors
Wajeh Y Qunibi, MD
William L Henrich, MD, MACP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
杨文领, 副主任医师

引言

患者接受的透析剂量会影响其病况和死亡率[1,2]。因此，正在进行维持性血液透析的患者的管理存在两个核心问题：确定应该开具的最佳透析剂量的处方和对个体患者实际接受的透析剂量进行定量。

患者症状的改善和血浆尿素氮(blood urea nitrogen, BUN)浓度的下降并不是判断透析充分性的精确指标，有以下两个原因：

●减轻尿毒症症状的透析剂量低于显示能够延长生存期的透析剂量。当在透析的同时开始使用促红细胞生成素治疗贫血时，这一点尤为正确，因为许多被认为是尿毒症所导致的症状实际上与贫血有关。(参见“非透析慢性肾脏病患者贫血的治疗”和“血液透析患者慢性肾脏病性贫血的促红细胞生成素治疗”)

●BUN值取决于多种与透析剂量不相关的因素，如蛋白质摄入量、蛋白质分解代谢率和残余肾功能。BUN值偏低可能反映营养不足，而非透析中尿素的充分清除。

所有用于测定透析剂量的方法都是基于尿素的清除。尽管还不清楚测定透析剂量的最佳方法，大多数肾脏专科医师使用Kt/V这一指标。本专题总结了Kt/V和其他一些用于测定个体患者接受的透析剂量的方法。我们也将讨论针对血液透析患者的透析剂量推荐。腹膜透析充分性的评估将在别处讨论(参见“腹膜透析的充分性”和“为何连续腹膜透析中Kt/V和肌酐清除率可能不相关”和“连续腹膜透析中溶质清除和超滤问题的探讨”)。与透析相关的患者结局将在别处讨论。 (参见“患者存活期和维持性透析”和“透析方式和患者结局”)

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-20.
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