Clinical Study Of Urea Clearance Rate Monitoring In Evaluating Hemodialysis Adequacy

Objectives:1、To explore the correlation between the Kt/Vocm of online clearance monitoring(OCM)and the spKt/V in maintenance hemodialysis(MHD)patients at the blood purification center of the Fifth Affiliated Hospital of Kunming Medical University,and to discuss whether Kt/Vocm and spKt/V can directly evaluate the quality of life of MHD patients,so as to provide a scientific and reasonable management mode for patients in the dialysis center and improve the quality of life of patients.2、To investigate the correlation between urea clearance rate and cardiovascular event risk in MHD patients.Methods:1、Collect the Kt/Vocm monitored by OCM at the end of dialysis and the spKt/V calculated with blood urea nitrogen collected from blood samples before and after dialysis of 50 MHD patients with end-stage renal disease(ESRD)in our hospital from November 2018 to January 2020,at the same time the kidney disease quality of life short form(KDQOL-SFTM 1.3)was used to evaluating the quality of life of the 50 dialysis patients,then analyze the correlation between the Kt/Vocm and spKt/V.and whether Kt/V can be directly used to evaluate the quality of life of the MHD patients.2、To collect the general data,medical history,and laboratory indicators of 71 MHD patients with ESRD in our hospital from November 2018 to January 2020,to calculate the Framingham cardiovascular risk score of these patients,so as to explore whether urea clearance rate is related to the risk of cardiovascular events.Results:1、There was a significant positive correlation between Kt/Vocm and spKt/V in MHD patients with ESRD,with the correlation coefficient r=0.855,P<0.01;SpKt/V value was higher than Kt/Vocm value,and there was a significant difference between them(P<0.01).There was no correlation between Kt/Vocm or spKt/V and the six areas scores of the quality of life score of MHD patients in our center which includes 36-item Short Form Health Survey(SF-36)、Physical component summary(PCS)、Mental component summary(MCS)、Health change(HT)、the 0-10 overall health rating items and Kidney Disease Targeted Areas(KDTA)(P≥0.05).2、There was a significant negative correlation between spKt/Vand the risk of cardiovascular events within 10 years.with the correlation coefficient r=-0.407(P<0.01).The difference in the risks of cardiovascular events within 10 years between the dialysis adequate group and the dialysis inadequate group was statistically significant(P<0.05),and the 10-year risk of cardiovascular events in the dialysis adequate group was significantly lower than that in the dialysis inadequate group.Conclusions:1、Online clearance monitoring can replace the spKt/V to evaluate hemodialysis adequacy of MHD patients to some extent,but it can not be directly used to evaluate the quality of life of MHD patients.The KDQOL-SFTM1.3 used to assess MHD patients’ quality of life can be used with objective parameters to evaluate and monitor the therapeutic effect of MHD patients.2、Urea clearance rate monitoring has a good clinical value in predicting the risk of cardiovascular events in MHD patients within 10 years.