nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-481Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESКлассические и online методы измерения kt/v: сопоставления и надежностьClassic and online methods for Kt/V measurement: comparison and reliabilityЗемченковГ. А.ZemchenkovG. A.zga13@yandex.ruСабодашА. Б.SabodashA. B.noemail@neicon.ruКазанцеваН. С.KazantsevaN. S.noemail@neicon.ruМакароваО. В.MakarovaO. V.noemail@neicon.ruЗемченковА. Ю.ZemchenkovA. Yu.noemail@neicon.ruБ. Браун Авитум Руссланд КлиниксРоссияB. Braun Avitum Russland ClinicsRussian FederationБ. Браун Авитум Руссланд Клиникс; Первый СПб ГМУ им. акад. И.П. ПавловаРоссияB. Braun Avitum Russland Clinics; I.P. Pavlov First Saint-Petersburg State medical universityRussian FederationСеверо-Западный ГМУ им. И.И. МечниковаРоссияB. Braun Avitum Russland Clinics; I.P. Pavlov First Saint-Petersburg State medical university; I.I. Mechnikov North-West State medical universityRussian Federation201522082024172173184Copyright © Земченков Г.А., Сабодаш А.Б., Казанцева Н.С., Макарова О.В., Земченков А.Ю., 20242024Земченков Г.А., Сабодаш А.Б., Казанцева Н.С., Макарова О.В., Земченков А.Ю.Zemchenkov G.A., Sabodash A.B., Kazantseva N.S., Makarova O.V., Zemchenkov A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/481

Цель работы: оценить соответствие результатов оценки обеспеченной дозы диализа классическим биохимическим методом и on-line спектрофотомерией отработанного диализата и проанализировать факторы, способные повлиять на точность метода. Методы: В течение календарного года 143 пациентам одного центра выполнено 1001 параллельное измерение Kt/V спектрофотомерией с помощью опции Ademia (Dialog Plus, BBraun) - UV-Kt/V и по формуле Daugirdas-II с пересчетом в выровненный eKt/V в качестве референтного метода. Результаты: Во всей группе пациентов UV-Kt/V составил 1,49±0,21 при eKt/V 1,40±0,19 (p<0,001). Отмечена высокая корреляция между двумя методами - r=0,868 (p<0,001). Систематическая ошибка спектрофотометрического метода в сравнении с классическим составила +5,7% (+0,083 единиц Kt/V), случайная - 7,3% (±0,106); связь между результатами лучше всего описывалась линейной функцией (eKt/V)=0,819×(UV-Kt/V)+0,194, R2=0,754. Величина расхождения между результатами не была связана со значением Kt/V, объемом ультрафильтрации, исходной концентрацией мочевины в крови или долей ее снижения, а также не зависела от пола, возраста, длительности ЗПТ и диагноза. Отмечена тенденция к увеличению расхождения (в пользу UV-Kt/V) при существенном отклонении скорости кровотока от среднего (311 мл/мин). На 87 (0,7%) сеансах из 12 381 зафиксировано искажение графиков on-line Kt/V, связанное с ухудшением забора крови (13% из этих случаев), эпизодами гипотонии (11%), рециркуляцией по сосудистому доступу (3%). Выводы: Определение Kt/V on-line по фотометрии отработанного диализата хорошо согласуется с классическим методом расчета по Daugirdas, позволяя контролировать обеспеченную дозу на каждом сеансе и выявлять причины отклонений. Перспективы улучшения точности метода связаны с совершенствованием алгоритма обработки данных фотометрии.

Aim: to compare the results of the delivered dialysis dose assessment by classical biochemical method and by on-line spectrophotometry of spent dialysate, to analyze the factors able to influence on-line method accuracy. Method: During a yearlong study in a single dialysis center in 143 patients the 1001 parallel Kt/V assessments by spectrophotometry with Ademia option (Dialog Plus, BBraun) - UV-Kt/V and by Daugirdas-II formula with calculation of Kt/V as reference. Results: In the whole group the mean UV-Kt/V was 1.49±0.21 and eKt/V was 1.40±0.19 (p<0.001). The correlation between two methods was high - r=0.868 (p<0.001). Systematic error of spectrophotometric method was +5.7% (+0.083 unit of Kt/V), a random error - 7.3% (±0.106). The linear function (eKt/V)=0.819×(UV-Kt/V)+0,194, R2=0.754 gave the best fit for describing relation between the results. The deviation was not related to Kt/V value, ultrafiltration volume, baseline urea level, urea reduction ratio as well as to age, gender, duration of renal replacement therapy and diagnosis. The discrepancy was slightly higher (in favor UV-Kt/V) at low and high extracorporeal blood flow compared to its mean value (311 ml/min). At 87 of 12 381 dialysis sessions (0.7%) we registered deformed graph of on-line Kt/V related to impairment of blood intake to extracorporeal (13% of such cases), hypotension (11%), access recirculation (3%). Conclusion: Determination of Kt/V on-line by spectrophotometry of spent dialysate is in good consistence with classic blood-side method. It enables the monitoring of delivered dialysis dose at each session and helps searching the reason for discrepancy. The outlook for increasing method accuracy is related with the improvement of the algorithms of spectrophotometry data processing.

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The authors declare that there are no conflicts of interest present.