More Dialysis Has Not Proven Much Better.
More Dialysis Has Not Proven Much Better.
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更多的透析并没有被证明更好。
DOI：
10.1111/sdi.12533
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发表时间：
2016
影响因子：
1.6
通讯作者：
Meyer,TimothyW
中科院分区：
文献类型：
--
作者：
O'Brien,FrankJ;Fong,KaraD;Sirich,TammyL;Meyer,TimothyW
维持标准每周三次血液透析的患者具有高死亡率和有限的生活质量。这种疾病中的一些是由于引起肾衰竭的全身性疾病，因此可能是不可逆的。但我们认为透析对正常肾功能的不完全替代是重要原因。血液透析患者的细胞外液量和无机离子浓度会发生波动，许多有机废物溶质的血浆水平仍然很高。因此，人们自然会认为，增加透析治疗的强度可以改善他们的健康状况。但是，尽管在过去20年里做了大量工作，但普遍缺乏证据表明可以取得这种改善。确实可以实现具体的好处。标准治疗无法控制透析中体重增加或血浆磷酸盐水平的患者可以从延长治疗时间中获益。但我们不能向普通患者承诺，更长时间或更频繁的治疗将降低死亡率或改善生活质量。
Patients maintained on standard three times weekly hemodialysis have a high mortality rate and a limited quality of life. Some of this illness is due to systemic diseases that have caused kidney failure, and thus may be irreversible. But we presume that imperfect replacement of normal kidney function by dialysis contributes importantly. Patients on hemodialysis are subject to fluctuations in extracellular fluid volume and inorganic ion concentrations and their plasma levels of many organic waste solutes remain very high. It is thus natural to suppose that their health could be improved by increasing the intensity of dialysis treatment. But despite a great deal of work over the past 20 years, evidence that such improvement can be obtained is generally lacking. Specific benefits can indeed be achieved. Patients who cannot control their intradialytic weight gains or plasma phosphate levels with standard therapy can benefit from extending treatment time. But we cannot promise the average patient that longer or more frequent treatment will reduce mortality or improve the quality of life.