Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients
Prognostic Value of the Delivery Dialysis Dose on Twice-Weekly Hemodialysis Patients
复制标题
每周两次血液透析患者的透析剂量的预后价值
DOI：
10.1159/000453043
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发表时间：
2017-01-01
影响因子：
4.2
通讯作者：
Pang, Huihua
中科院分区：
文献类型：
--
作者：
Fan, Qichen;Yan, Yucheng;Pang, Huihua
背景：很少有研究评价每周两次血液透析（HD）中透析剂量的预后价值。单池Kt/V（spKt/V）超过1.70可能使接受每周两次维持HD的患者受益。方法：这是一项多中心随机对照试验，在上海17个透析中心的163例患者中进行，将其分配到高剂量组（n = 98）和标准剂量组（n = 65），并随访96周的研究期。给予治疗方法，使高剂量组的spKt/V增加至1.70以上。每12-24周收集一次数据。主要结局为全因死亡率和主要不良心脑血管事件（MACE）发生率，次要结局包括残余肾功能（RKF）和健康相关生活质量（HR-QOL）。结果：高剂量组和标准剂量组的spKt/V在8周干预后分别为1.80 ± 0.23和1.55 ± 0.19（p < 0.001）。研究结束时，高剂量组SF-36身体功能评分和总分分别为82（69-90）和74（47-84），均高于标准剂量组。两组均观察到尿量下降，无显著差异（p = 0.431）。两组之间的总生存期无差异（p = 0.580）。高剂量组1年无MACE生存率为84.49%，优于标准剂量组的76.72%（p = 0.029）。结论：较高的spKt/V也与无MACE生存率和较好的HR-QOL相关，特别是在每周两次透析患者的身体功能方面。在每周两次HD人群中增加spKt/V超过1.70不会导致RKF丢失。
Background: Few studies have evaluated the prognostic value of dialysis dose in twice-weekly hemodialysis (HD). A single-pool Kt/V (spKt/V) over 1.70 may benefit patients receiving twice-weekly maintenance HD. Methods: This is a multicenter randomized controlled trial performed on 163 patients from 17 dialysis centers in Shanghai who were allocated to high- (n = 98) and standard-dose groups (n = 65) and followed through 96 weeks of study period. Therapeutic approaches were given to increase spKt/V to over 1.70 in the high-dose group. Data were collected every 12-24 weeks. The primary outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACEs) occurrence, and secondary outcomes included residual kidney function (RKF) and health-related quality of life (HR-QOL). Results: The spKt/V in high-dose and standard-dose groups were 1.80 ± 0.23 and 1.55 ± 0.19, respectively, after an 8-week intervention (p < 0.001). At the end of the study, SF-36 physical function and total score in high-dose group were 82 (69-90) and 74 (47-84), respectively, both of which were higher than those in the standard-dose group. Decline in urine volume was observed in both groups with no significant difference (p = 0.431). No difference was found in overall survival between the 2 groups (p = 0.580). The 1-year MACE-free survival for high-dose group was 84.49%, better than 76.72% for standard-dose group (p = 0.029). Conclusions: Higher spKt/V is also associated with MACE-free survival and better HR-QOL, especially in physical function aspect for twice-weekly dialysis patients. Increasing spKt/V over 1.70 in twice-weekly HD population does not cause loss of RKF.