Prescribing Hemodialysis: A Guide to Urea Modeling

摘要: 1. Uremic Toxins & Dialysis.- The uremic syndrome.- Role of protein nitrogen metabolism.- Clinical measurement uremia.- Effect dialysis on the Proposed toxins.- Alternatives to single-toxin theory.- Protein and tissue binding proposed Toxic contributions itself.- Where urea fits into toxin theories.- 2. Urea Metabolism: Chemistry Urea.- Excretion nitrogenous waste products: comparative physiology.- Biochemistry urea.- Inborn errors metabolism: cycle enzymopathies.- transport.- Nitrogen recycling.- Methods measurement.- toxicity 3. Modeling: Introduction.- Definition modeling.- Evolution Why instead other solutes?.- Quantifying hemodialysis therapy.- Quality assurance programs modeling development techniques.- What is purpose modeling?.- for high-flux, short-duration dialysis.- clinical data are provided by Significance distribution volume (V).- generation rate (G).- Components prescription.- Measures prescription effectiveness.- 4. Single-Compartment Model.- Models kinetics.- Overview kinetic analysis.- Laws diffusion.- First-order kinetics: clearance, constant, half-life, exponential decline.- single-compartment model.- Constant-volume model, three BUN measurements.- Evaluation constant-volume Variable-volume Source code variable-volume values.- Two-BUN method, variable volume.- Comparison two-BUN method with three-BUN method.- two 5. Multicompartment Models.- compartments in normal humans.- Limitations Description two-compartment Site generation.- Postdialysis rebound concentration.- Two-compartment Solutions equations Graphic description High-flux compartments.- Solutes low mass transfer coefficients.- Measuring intercompartment area coefficient.- A comparison one-compartment models.- direct quantification Impact pool number calculated variables.- Determinants postdialysis rebound.- model ECF ICF magnitude intracellular swelling.- Additional Recommendations regarding one versus Blood sampling techniques precautions.- 6. Practical Solution: Ureakin.- Value computer program.- Theoretical basis Conventions assumptions.- Files file extensions used UREAKIN.- Options available from main menu.- Refinements 7. Application Modeling.- blood concentrations.- Compensation plasma water content.- Dialyzer clearance.- fluid balance Recirculation dialyzer venous blood.- Residual (native kidney) clearance: its significance.- Simplified methods 8. Dialysis: How Much Enough?.- Historical methods.- Kt/V: yardstick outcome.- adequacy Comparing outcome 9. Examples Case 1: Expected results an average adult patient.- 2: case no residual function weight gain between dialyses effect changing Kd..- 3: patient significant renal (Kr).- 4: Effects habitually large gains dialyses.- 5: high intake.- 6: 7: treated high-flux 8: whose clearance (Kd) varies expected 9: Small patients pediatric 10. Future.- Dialysis treatments end-stage failure.- Outcome parameters More complex Modeling solutes.- Better markers Improved flow monitoring.- Dialysate Real-time monitoring total-care perspective.- Appendicies.- Appendix A. a single-compartment, model: B. C. two-compartment, fixed-volume D. Numerical solution variable-ECV E. osmotic ECV ICV.- F. Interpreting G. Useful equations.- H. collection forms.- I. reports.