Appraisal On Hemodialysis Adequacy And Nutritional Status

Objective:To realize the effect and significance of applying formal urea kinetics model to appraise hemodialysis sufficiency and nutritional status,the correlation among various parameters,and that among parameters,patient body square,residual renal function,dialysis frequency,and bood albumin.Methods:32patients,on stable condition,undergoing hemodialysis treatment more than 3 months,receive dialysis twice or thrice a week.On measuring their residual renal function ,both pre-dialysis and post-dialysis BUN twice ,we track their equilibrated KT/V,PCR, TA- Curea,URR respectively before average,while measuring their pre-dialysis Alb and getting their physical square as per height and weight.Groping the patients according to dialysis twice a week and thrice a week ,as well as urine patients and urineless patients.Through the study,it is required to keep dialysis prescription unchanged,every session length 240 mins-270 mins,blood flow 220- 260 ml/min,dialy-sate flow 500 ml/min.Machine type is Swedish Gambro Ak-95 ,acetate membrane with acreage 1.5m2,and hydrocarbon dialysate,are same.To ensure the consistency in procedures and data comparability,the study is carried out in such uniformity that,to a single patient,dialysis mac- hine and blood flow remain fixed,so do the dialyzer,angio-access, and inner fistula needle,while true session length varying within±3mins, dry weght within±0.5Kg,weight scale error within±0.1Kg, and height measure error within±2cm.Pre-dialysis-blood sample is obtained by empty needle from the arterial end ,while post-dialysis-blood sample is taken from arterial end sampling place (before the blood-pump) during the last 15 mins when blood pump flow reduced to 100 ml/min.As to those with urine volume over 100 ml,during the interval of two consecutive sessions,the total urine volume and cubic are recorded, urine sample is collected.With blood and urine BUN tested by rule using HITACHI 7020 automatic bio-chemical analyzer,blood Alb,urine protein concentration were also measured,all results will be denoted by?X±S,processed by statistics software SPSS 8.0 for the correlation analysis and inde- pendent inspection.Result:A.It states of all 32 patients average TACurea=16.05±3.43mmol/l,URR=74.97±1.71%,PCR=1.55±0.23g/Kg/d,KT/V=1.66±0.08,pre(Alb)=41.34±3.35g/l,pre(BUN)=25.70±4.17mmol/l,pre(Cr)=958.75±176.83umol/l.B.If patients undergoing dialysis twice a week compared with those thrice a week,average UKM parameters show that,with TACurea being 17.18±1.98mmol/l versus 14.78±3.49mmol/l(p=0.001),URR 75.54±1.58% versus 74.23±1.35%(p>0.05),PCR 1.43±0.18g/Kg/d ver- sus 1.63±0.23g/Kg/d(p<0.001),KT/V 1.68±0.76 versus 1.62±0.72 (p> 0.05), pre-dialysis Alb 38.65±1.49g/l versus 42.95±3.11g/l(p< 0.001), pre-dislysis BUN 28.24±4.04mmol/l versus 24.39±.63mmol/l (p<0.001), pre-dialysis Cr 1034.92±156.22umol/l versus 913.05±174.38 umol/l (p<0.01),great difference occur in TACurea, PCR,pre-dialysis Alb, pre-dialysis BUN as well as pre-dialysis Cr,while UUR and KT/V vary slightly.C.If the 16 urineless patients compared with the other 16 patients by KT/V 1.58±0.05 versus 1.62±0.09(P>0.05),PCR 1.49±0.21g/Kg/d versus 1.61±0.24g/Kg/d(p<0.05),TACurea 15.77±2.46mmol/l versus 16.34±4.20mmol/l(p>0.05),pre-dialysis Cr 930.00±171.72umol/l versus 987.50±179.84umol/l(p>0.05),it reveals that PCR differ substantially, but KT/V and pre-dialysis Cr and TACurea differ slightly.D.It reads that between the 12 patients of weekly twice dialysis and other 20 of thrice,neither patients′physical square (p>0.05),nor the session length or blood flow volume (p>0.05),vary dramatically, and that the physical square negatively relates with PCR,URR, KT/V (p<0.05).Conclusing:KT/V is not a reliable indicatior as it varies unno-ticeably even if TACurea and PCR differ dramatically for patients of weekly twice dialysis and ones of thrice,therefore,in order to accu- rately assess the dialysis adequacy and nutritional status of patient on dialysis,we well have to take tACurea,KT/V,and PCR into condi- deration.