IMPROVEMENT OF DECISIONS REGARDING HEMODIALYSIS-PATIENTS BY UREA KINETIC MODELING

被引:6
作者
BUUR, T [1 ]
TIMPKA, T [1 ]
机构
[1] LINKOPING UNIV, DEPT COMP & INFORMAT SCI, S-58185 LINKOPING, SWEDEN
关键词
decision making; hemodialysis; Key words: computer; practice research; urea kinetic modeling. (Med Decis Making 1990; 10:274-282);
D O I
10.1177/0272989X9001000405
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
The potentials for improving decisions about adequacy of dialysis (AD) and daily protein intake (DPI) by urea kinetic modeling (UKM) were examined. Four nephrologists evaluated AD, DPI, and metabolic stability in 62 patients. UKM was done three times; but the results were not revealed. Clinicians’ decisions were then compared with UKM measures of effective dialysis (Kt/V) and protein catabolic rate (pcr). Detection of inadequately treated patients by the clinicians was poor (28%, Kt/V < 1.0; and 40%, Kt/V < 0.9). Specificities of the clinicians’ decisions were 0.96 and 0.92, respectively. Combining pcr and consensus decisions, 59 patients could be assigned a probable DPI. Using this as “gold standard,” the average clinician detected 77% of 13 low DPls. Single or triple pcr determinations alone detected 77% or 62%, respectively. Specificities were 0.91, 0.85, and 1.0. Simulated decision making suggested that combining pcr with clinical evaluation in a logical way would lead to detection of most patients with low DPI. Qualitative data from individual patient cases causing con troversies are presented and discussed. It is concluded the UKM should be used routinely to assess the adequacy of dialysis and daily protein intake. © 1990, Sage Publications. All rights reserved.
引用
收藏
页码:274 / 282
页数:9
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