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題 名 | Significance of Nitrogen Removal Mass in Uremic Patients on Different Modalities of Dialysis Therapy=尿毒症病患在不同透析治療方式時氮移除量之意義 |
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作 者 | 陳振文; 黃東波; 王茂齡; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 99:2 2000.02[民89.02] |
頁 次 | 頁116-122 |
分類號 | 415.816 |
關鍵詞 | 尿毒症; 氮移除量; Kt/V; Dialysate urea nitrogen; Urea generation rate; Protein catabolic rate; Weekly removal mass of urea; Nitrogen; Normalized weekly removal mass of urea nitrogen; |
語 文 | 英文(English) |
英文摘要 | Background and purpose: While most nephrologists use Kt/V values for dialysis prescriptions, some researchers are beginning to view the role of solute removal mass as an indicator of adequate dialysis. This study, using nitrogen as a surrogate for solute removal, probed whether solute removal mass can be used as the target of adequate dialysis. Mathematical formulas for easy bedside calculation of nitrogen removal mass were used to avoid the problems associated with direct measurement. Methods: The weekly removal mass of urea nitrogen (M) and the urea generation rate (G) of 32 conventional hemodialysis (HD) and 21 continuous ambulatory peritoneal dialysis (CAPD) patients were calculated. All the patients were anuric, clinically stable, and under adequate dialysis pursuant to either the criterion of the urea index, Kt/V, or clinical requirements. Results: The difference in M □ (M □ = 41.9 □ 9.5 g/week, M □ = 38.8 □ 11.9 g/week) and G (G □ = 3.90 □ 1.02 mg/min, G □ = 3.85 □ 1.21 mg/min) between the two groups was statistically insignificant (p = 0.119 and p = 0.868, respectively). When protein nitrogen leaking through the peritoneal membrane was considered and added to M□, nitrogen removal in CAPD patients (M □ = 42.3 □ 13.0 g/week) approached that in HD patients (p = 0.886). There was no correlation between dialysis dosage and urea removal mass in either the CAPD or HD groups. Conclusions: Urea nitrogen removal mass is similar to the protein catabolic rate (PCR) in stable patients. It is meaningful in dialysis evaluation only when it is used simultaneously with blood urea nitrogen measurement. However, because M changes at the inception of dialysis, it more significant than PCR in the evaluation of unstable patients. |
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