60-66 /1385 /2 8 / *** *** ** 1 * *** - ** - *. - 85/5/16 : - 85/1/24 : : :... :. 200. 250..( 4 ).. t (K=Clearance dialyzer, T= Time, V=Volume of distribation of urea) KT/V : (Urea Reduction Ratio) URR 1/195±0/456 0/943±0/335 250 200. 60/178±10/74 250 53/3±13/6 200.(p<0/05) %25 :.. :.(1) 5 4 64 60.(3 2) :. 10 7 44 40 1 0811-8222401 : - : 60 E-mail: edu1374@yahoo.com
..(17-21). (23 22) KT/V (24)..(25).(26 11) (21 18 17)..(4-10) NCDS.(11) (National Cooperative Dialysis Study).(3). KT/V. KT/V KT/V urea...(14 13 12) URR URR (Urea Reduction Ratio).(15) KT/V 65 URR 1/2 KT/V (URR).(16).. 61
1385 /2 8 /. 4 ).( 50.. Daugirdas II.(28 27) (URR).. t. : 66/7 40 49 (%28/6) 54/8 60 (%28/6) :. : 3.. ().. 200 250. ) (. 62
250 200 URR :1 250 200 URR 00/0 0 9/5 4 25-34 7/1 3 11/9 5 35-44 19/0 8 40/5 17 45-54 38/1 16 21/4 9 55-64 35/7 15 16/7 7 65-75 URR=Urea Reduction Ratio. p<0/05 t - 61/9 55-64 (54 ) URR 16/6 KT/V.(1 ) 1/3-1/7 KT/V 45/2 (2 ) 0/9 1/2 1-3 61/9. 16/7 200 21/4 65 URR 250 200 KT/V :2 250 200 KT/V 23/8 10 38/1 16 0/3-0/8 50 21 45/2 19 0/9-1/2 21/4 9 11/9 5 1/3-1/7 4/8 2 4/8 2 1/8-5 KT/V: K=Clearance, T=Time, V=Volume of distribution urea.. p<0/05 t - 63
1385 /2 8 / (32) KT/V=1/2 0/1 (22) 5-7.(25 23 22) : 400 200 33.(25) 250. :. 200 0/943±0/335 KT/V. 250 1/195±0/456 53/30±13/61 200 URR t. 60/118±10/74 250 95. KT/V URR : 16/66 200 16/7 (M=0/49) 1/3 KT/V (M=53/3) 65-75 URR KT/V ) (30) (1/3 KT/V ) (29) (1/67 (0/9±0/26 ) (1/03±0/25 ) (20) (1/2 %80) (18) (1/2 %90) (19). kim 15-20 KT/V (24) 1/2..(31) KT/V 0/1 USRDS 64
: 1. Gutzwiller JP, Schneditz D, Huber AR, Schindler C, Gutzwiller F, Zehnder CE. Estimating phosphate removal in hemodialysis: an additional tool to quantify dialysis dose. Nephrol Dial Transplant. 2002; 17(6): 1038. 2. Port FK, Ashby VB, Dhingra RK, Roys EC, Wolf RA. Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients. J Am Soc Nephrol. 2002; 13: 1061-6. 3. Hakim RM. Assessing the adequacy of dialysis. Kidney Int. 1990; 37: 822-32. 4. Owen WF, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med. 1993; 329: 1-6. 5. Collins AJ, Ma JZ, Umen A, Keshaviah P. Urea index and other predictors of hemodialysis patient survival. Am J Kidney Dis. 1994; 23: 272-82. 6. Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription on patient morbidity. N Engl J Med. 1991; 305: 1176-80. 7. Hakim RM, Breyer J, Ismail N, Schulman G. Effects of dose of dialysis on morbidity and mortality. Am J Kidney Dis. 1994; 23: 661-9. 8. Lowrie EG. Chronic dialysis treatment: clinical outcome and related processes of care. Am J Kidney Dis. 1994; 24: 255-66. 9. Gotch F, Levin NW, Port FK, Wolfe RA. Clinical outcome relative to the dose of dialysis is not what you think: the fallacy of the mean. Am J Kidney Dis. 1997; 30: 1-15. 10. Owen WF, Chertow G, Lazarus JM, Lowrie EG. The dose of hemodialysis: Mortality responses by race and gender. JAMA. 1998; 280: 1-6. 11. Sehgal AR, Dor A, Tsai AC. Morbidity and cost implication of inadequate hemodialysis. Am J Kidney. 2001; 37(6): 1223-31. 12. Hemodialysis adequacy work group. Dialysis outcomes quality initiative (DOQI). Am J Kidney Dis. 30(suppl2): 1997; 22-31. 13. Gotch FA, Sargent JA. A mechanistic analysis of the national cooperative dialysis study (NCDS). Kidney Int. 1985; 28: 526 34. 14. Held PJ, Port FK, Wolfe RA, Stannard DC. The dose of hemodialysis and patient mortality. Kidney Int. 1996; 50(2): 550 6. 15. U.s department of health and human services. Hemodialysis dose and adequacy. NIH Publication. No.03-4556 Septamber 2003. 16. Lindsay RM, Spanner E. Adequacy of hemodialysis in the elderly. Geriatr Nephrol Urol. 1997; 7(3): 147-56...17.20-25 :23 1381. 1387..18.52-7 :14 1383..1381 65
1385 /2 8 / ( )...19.40-6 :(41)13 1382. - 1379...20.82-7 :17 1380. -.1377...21.27-33 :(3)10 1382. 22. Cigarran S, Coronel F, Torrente J, Sevilla M. Risk of inadequate dialysis dose in hemodialysis patients with high Watson volume. Hemodialysis Int. 2004; 8(1): 84. 23. Hauk M, Kuhlmann MK, Riegel W, Kohler H. Invivo effects of dialysate flow rate on Kt/v in maintenance hemodialysis patients. Am J Kidney Dis. 2000; 35(1): 105-11. 24. Kim YO, Song WJ, Yoon SA, Shin MJ, Song HC, Kim YS, et al. The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients with low Kt/v. Hemodialysis Int. 2004; Vol 8. 85. 25. Daugirdas JT, Van Stone JC, Boag JT. Hemodialysis apparatus. In: Daugirdas JT, Blake PG, Ing TS (eds.). Handbook of dialysis. Philadelphia: Lippincott Williams & Wilkins Company; 3 th ed. 2001. p: 46-66..1377....26 27. Kovacic V. The assessment of hemodialysis technical efficacy. Official publication of the Indian. J Nephrol. 2004; 14(1): 1-9. 28. Kovacic V, Roguljic L, Jukic I. Comparision of methods for hemodialysis dose calculation. Dialysis & Transplantation. 2003; 32(4): 170-5. 29. Charra B, Calemard E, Ruffet M, Man NK. Survival as an index of adequacy of dialysis. Kidney Int. 1992; 41: 1286-91. 30. Collins AJ, Ma JZ, Umen A, Keshaviah P. Urea index and other predictors of hemodialysis patient survival. Am J Kidney Did. 1994; 23(2): 272-82. 31. Gutzwiller JP, Schneditz D, Huber AR, Schindler C, Garbani E, Zehnder CE. Increasing blood flow increase kt/v and potassium removal but fails to improve phosphate removal. Clin Nephrol. 2003; 59(2): 130-6. 32. Bloembergen WE, Stannard DC, Port FK. Relationship of dose of hemodialysis and cause-specific mortality. Kidney Int. 1996; 50: 557-65. 66