Author: Leo
Keywords: nephropathy
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| From google images |
In order to facilitate the judge, I will probably list some of the control range of the indicators (for reference only)
Part 1
- hemoglobin Hb (hemoglobin) -
2007 K / DOQI proposed target value of hemoglobin: 110 ~ 120g / L. Transferrin saturation less than 20% and blood ferritin concentration less than 100 ng / ml suggest iron deficiency.
▲ 2012 KDIGO anemia guidelines recommend:
For patients with CKD stage 5 dialysis, it is recommended to initiate erythropoietin (ESA) treatment when the hemoglobin concentration is 90-100 g / L to avoid hemoglobin concentration below 90 g / L. Because some patients in the higher hemoglobin concentration of quality of life will be improved, this time can be given individual treatment, that is, hemoglobin concentration> 100 g / L, can also be given erythropoietin (ESA) treatment. Under normal circumstances, it is recommended to use erythropoietin to maintain hemoglobin concentration should not exceed 115 g / L. For all patients, it is recommended not to use erythropoietin to increase the hemoglobin concentration by more than 130 g / L.
"China's hemodialysis adequacy clinical practice guide" (2015) recommendations:
Recommended Hb ≥ 100 g / L, and <130 g / L; recommended Hb level maintained at 110 ~ 130 g / L.
Target value of hemoglobin: 110 ~ 120g / L.
Personal comparison recommended:
In addition, anti-inflammatory treatment; full dialysis; reduce complications (correct calcium and phosphorus metabolism disorders, treatment of hyperparathyroidism); use long-acting erythropoietin; increase endogenous erythropoietin reactivity; iron, water Vitamins (B1, B6, C, folic acid, B12), and the proper use of copper, lipoic acid and levulose, are beneficial for the promotion of hemoglobin.
Part 2
- Calcium and phosphorus and paracetamone -
KDOGI guidelines recommend:
Blood phosphorus was controlled at 0.87 ~ 1.45mmol / L, calcium was controlled at 2.10 ~ 2.54 mmol / L, and parathyroid hormone (PTH) was controlled at 16.5 ~ 62.1 pmol / L (150 ~ 565 ng / L).
(Also information suggest: parathyroid hormone control in the 130 ~ 600 ng / L)
"China's hemodialysis adequacy clinical practice guide" (2015) recommendations:
Before the correction of serum calcium: 2.10 ~ 2.75 mmol / L; pre-blood phosphorus: 1.13 ~ 1.78 mmol / L; pre-blood iPTH: 150 ~ 300 ng / L.
Depending on the calcium concentration of the dialysis fluid used by the individual, the control of the respective calcium, phosphorus and paracetamins is determined by the difference in individual calcium and phosphorus loads.
Personal comparison recommended:
1.75 (high calcium) dialysis solution: dialysis, calcium significantly, after the blood calcium was significantly increased, calcium load increased significantly, it is recommended: before the correction of calcium: 2.10 ~ 2.30 mmol / L (up to not more than 2.5mmol / L); pre-transfusion phosphorus: 1.10 ~ 1.78 mmol / L; forward blood iPTH: 150 ~ 300 ng / L.
1.50 (Pu calcium) dialysis solution: dialysis, a small amount of calcium, slightly increased after calcium, calcium load increased slightly, it is recommended: before the correction of calcium: 2.20 ~ 2.40 mmol / L (up to not more than 2.54 Mmol / L); pre-transfusion phosphorus: 1.10 ~ 1.78 mmol / L; pre-blood iPTH: 100 ~ 200 ng / L.
1.25 (low calcium) dialysis solution: dialysis, calcium is basically stable or a small amount of loss, through the blood calcium is basically stable or slightly decreased, calcium load decreased, it is recommended: before the correction of calcium: 2.30 ~ 2.50 mmol / L No more than 2.75mmol / L); proapoptotic phosphorus: 1.10 ~ 1.78 mmol / L; calcium and phosphorus product: <55; pre-blood iPTH: 65 ~ 150 ng / L.
Part 3
C-reactive protein and β2-microglobulin
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C-reactive protein and β2-microglobulin are important indicators of micro-inflammation, in the conditions permitting, naturally the lower the better.
C - reactive protein as far as possible within the normal range (<5mg / L);
Β2 microglobulin as far as possible in the normal range of the upper limit of 15 to 20 times (<30 ~ 50mg / L).
Part 4
- creatinine and urea (nitrogen) -
Creatinine: Molecular formula: C4H7N3O; Molecular weight: 113.1; before the start of dialysis (renal failure stage), are generally measured with creatinine renal dysfunction. Because creatinine is less affected by food than urea. After the start of dialysis, creatinine can be assessed from the side of the nutritional status of patients and activities, creatinine is generally more than 1000 umol / L or so, creatinine is too low (<600 umol / L) may prompt the patient malnutrition, muscle mass reduction , Lack of exercise, etc., creatinine is too high (> 1500 umol / L) may suggest that dialysis is not sufficient.
Urea: Molecular formula: CON2H4; Molecular weight: 60; After the start of dialysis, urea (nitrogen) is generally used to measure the efficiency of dialysis. Because urea (nitrogen) toxicity is higher than creatinine, and the number of urea (nitrogen) more than 10 times more than creatinine, it can be used as a representative of small molecule toxins. General requirements: before the urea nitrogen (BUN) to 21.4 mmol / L or more, in order to ensure a better nutritional status of patients, reduce complications and reduce mortality. After urea urea is about one-third before the urea nitrogen clearance rate of 65%. However, excessive urea nitrogen (> 30 mmol / L) may indicate insufficient dialysis, or high metabolic status.
hint
Under normal circumstances, the ratio of blood urea nitrogen to creatinine (BUN / Scr) is about 10, high protein diet, high metabolic status, water shortage, renal ischemia, lack of blood volume and some acute glomerulonephritis Can increase the ratio, or even up to 20 to 30; and low-protein diet, liver disease often make the ratio decreased, this time can be called low azotemia.
Part 5
- Carbon dioxide binding capacity -
"China's hemodialysis adequacy clinical practice guide" (2015) recommendations:
Hemodialysis patients should be dry weight. Recommended dialysis interval weight growth rate <5% dry weight; recommended dialysis before CO2 or HCO3-≥ 20 mmol / L, and <26 mmol / L.
Metabolic acidosis correction of common causes: dialysis times, a single dialysis time is shorter, dialysis solution buffer alkali concentration is low, reverse osmosis and concentration of A, B liquid inappropriate proportion, dialysis fluid flow or blood flow is low.
There are experts suggest that: before the blood HCO3-concentration at 22 mmol / L or so, after dialysis at 28 mmol / L or so, more appropriate.
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