장기 혈액 투석 환자에서 주당 투석 회수에 따른 투석 적절도 비교 = Comparison of Adequacy of Dialysis According to Frequency of Dialysis per Week in Ptients Undergoing Maintenance Hemodialysis

국문 초록 (Abstract)

장기 혈액 투석을 받고 있는 만성 신부전 환자의 주당 투석 회수에 따른 투석 적절도를 비교 평가하기 위해 요소 동력학 모형을 이용하여 구한 지표와 혈청내 각종 생화학적 영양 지표를 측정하였다.

다국어 초록 (Multilingual Abstract)

Objectives : To assess adequacy of dialysis according to frequency of hemodialysis per week in patients with end stage renal diseases, we calculated the dose of dialysis with urea kinetic modeling and checked serum levels of several biochemical nutritional parameters. And then, we compared above values.
Methods and Materials : We selected 40 patients undergoing maintenance hemodialysis over 3 months from January 1993 to December 1994. We divided them 2 groups such as group 1, those who had taken hemodialysis three times(23) a week, and group 2, those who had taken hemodialysis 2 times(17) a week. Monthly, we checked pre-hemodialysis serum bevels of biochemical nutritional parameters such as cholesterol, BUN, creatinine, potassium, phosphorus and albumin, measured their arterial pressures at blood sampling day, and calculated Kt/V urea, weekly Kt/V urea, NPCR(normalized protein catabolic rate) and URR(urea reduction ratio) with urea kinetic modeling during study periods. After then, we calculated their mean values.
Results :
1) Clinical characteristics
Mean ages were 47.82±2.58 years in group 1 and 48.34±2.77 years in group 2. There was no statistical difference in mean age between two groups. Mean dialyzer blood flow rates were 227.10±4.40mL/min in group 1 and 239.78±2.70mL/min in group 2, and total minutes per sessions 236.03±3.33 min in group 1 and 285.26±3.52 min in group 2. There were statistical differences in level of mean dialyzer blood flow ramie and total minutes per session between two groups (p<0.01).
2) Serum biochemical nutritional parameters
In group 1 and group 2, mean values of serum concentration of cholesterol were 150.43±9.13mg/dL and 146.62±773mg/dL, those of BUN 72.10±3.85mg/dL and 75.51±3.79mg/dL, those of creatinine 10.02±0.60mg/dL and 11.36±0.76mg/dL, those of potassium 5.33±0.16mEq/L and 5.50±0.14mEq/L, those of phosphorus 4.81±0.24mg/dL and 5.05±0.32mg/dL, and those of albumin 3.96±0.11g/dL and 4.11±0.05g/dL, respectively. There was no statistical difference in mean pre-hemodialysis serum concentrations of cholesterol, BUN, creatinine, potassium, phosphorus and albumin between two groups. Serum level of creatinine showed positive correlation with that of albumin(r = 0.514, p<0.01) in study patients.
3) Urea kinetic modeling parameters
In group 1 and group 2, mean values of Kt/V urea were 1.09±0.05 and 1.47±0.05, those of weekly Kt/V urea 3.25±0.15 and 2.94±0.09, and those of URR 0.60±0.01 and 0.71±0.02, respectively. There were statistical differences in mean values of UKM parameters such as Kt/V urea, weekly Kt/V urea and URR between two groups(p<0.01) Mean value of NPCR was 0.94±0.04g/kg/day in group 1 and 0.85±0.03g/kg/day in group 2. There was statistical difference in mean value of NPCR between two groups(p<0.05). Supposed no residual renal clearance, NPCR showed positive correlation with weekly-Kt/V urea (r = 0.413, p<0.01).
4) Mean arterial pressure
Mean arterial pressures were 109.48±3.77mmHg in group 1 and 111.61±1.99mmHg in group 2. There was no statistical difference between two groups.
Conclusion : In assessment of adequacy of hemodialysis according to the frequency per week, we could conclude that no difference in serum biochemical nutritional parameters including albumin between two groups, despite of less weekly-Kt/V urea in group 2 than that in group 1, was due to faster blood flow and longer total minutes per session during hemodialysis(i.e., increase in Kt/V urea and urea reduction ratio) in group 2. So, we can overcome the difference in weekly-Kt/V urea even in those who take hemodialysis two times a week, if we Increase the level of Kt/V urea or urea reduction ratio during hemodialysis.

목차 (Table of Contents)

• Ⅰ.서론
• Ⅱ.대상 및 방법
• 1.대상
• 2.방법
• 3.통계처리
• Ⅲ.결과
• 1.대상 환자의 임상적 특성(Table 1)
• 2.혈청 생화학적 영양 지표의 비교(Table 2)
• 3.요소 동력학 모형을 이용한 지표의 비교(Table 2)
• 4.평균 동맥 혈압의 비교(Table 1)
• Ⅳ.고찰
• Ⅴ.결론