In-center hemodialysis six times per week versus three times per week.
In-center hemodialysis six times per week versus three times per week.
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DOI：
10.1056/nejmoa1001593
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发表时间：
2010-12-09
期刊：
影响因子：
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通讯作者：
Kliger AS
中科院分区：
文献类型：
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作者：
FHN Trial Group;Chertow GM;Levin NW;Beck GJ;Depner TA;Eggers PW;Gassman JJ;Gorodetskaya I;Greene T;James S;Larive B;Lindsay RM;Mehta RL;Miller B;Ornt DB;Rajagopalan S;Rastogi A;Rocco MV;Schiller B;Sergeyeva O;Schulman G;Ting GO;Unruh ML;Star RA;Kliger AS
在这项随机临床试验中，我们的目的是确定增加中心血液透析的频率是否会对接受维持性血液透析的患者的左心室质量、自我报告的身体健康状况和其他中间结果产生有益的变化。患者被随机分配接受每周 6 次血液透析（频繁血液透析，125 名患者）或每周 3 次（传统血液透析，120 名患者），为期 12 个月。两个共同主要复合结局是通过心脏磁共振成像评估的死亡或左心室质量变化（从基线到 12 个月），以及 RAND 36 项健康调查的身体健康综合评分的死亡或变化。次要结果包括认知表现；自我报告的抑郁症；营养、矿物质代谢和贫血的实验室标志物；血压;以及与血管通路相关的住院率和干预率。频繁血液透析组的患者平均每周进行 5.2 次血液透析；频繁血液透析组的每周标准 Kt/Vurea（尿素清除率与透析持续时间的乘积，标准化为尿素分布容积）显着高于常规血液透析组（3.54±0.56 vs. 2.49±0.27）。频繁的血液透析与两个主要综合结果的显着益处相关（死亡或左心室质量增加的风险比，0.61；95%置信区间[CI]，0.46至0.82；死亡或身体健康综合评分下降的风险比，0.70；95% CI，0.53至0.92）。被随机分配进行频繁血液透析的患者比被分配进行传统血液透析的患者更有可能接受与血管通路相关的干预措施（风险比，1.71；95% CI，1.08至2.73）。频繁的血液透析与改善高血压和高磷血症的控制有关。频繁的血液透析对认知能力、自我报告的抑郁症、血清白蛋白浓度或红细胞生成刺激剂的使用没有显着影响。与传统血液透析相比，频繁的血液透析与死亡或左心室质量变化以及死亡或身体健康综合评分变化的综合结果相关，但促使更频繁地采取与血管通路相关的干预措施。
In this randomized clinical trial, we aimed to determine whether increasing the frequency of in-center hemodialysis would result in beneficial changes in left ventricular mass, self-reported physical health, and other intermediate outcomes among patients undergoing maintenance hemodialysis. Patients were randomly assigned to undergo hemodialysis six times per week (frequent hemodialysis, 125 patients) or three times per week (conventional hemodialysis, 120 patients) for 12 months. The two coprimary composite outcomes were death or change (from baseline to 12 months) in left ventricular mass, as assessed by cardiac magnetic resonance imaging, and death or change in the physical-health composite score of the RAND 36-item health survey. Secondary outcomes included cognitive performance; self-reported depression; laboratory markers of nutrition, mineral metabolism, and anemia; blood pressure; and rates of hospitalization and of interventions related to vascular access. Patients in the frequent-hemodialysis group averaged 5.2 sessions per week; the weekly standard Kt/Vurea (the product of the urea clearance and the duration of the dialysis session normalized to the volume of distribution of urea) was significantly higher in the frequent-hemodialysis group than in the conventional-hemodialysis group (3.54±0.56 vs. 2.49±0.27). Frequent hemodialysis was associated with significant benefits with respect to both coprimary composite outcomes (hazard ratio for death or increase in left ventricular mass, 0.61; 95% confidence interval [CI], 0.46 to 0.82; hazard ratio for death or a decrease in the physical-health composite score, 0.70; 95% CI, 0.53 to 0.92). Patients randomly assigned to frequent hemodialysis were more likely to undergo interventions related to vascular access than were patients assigned to conventional hemodialysis (hazard ratio, 1.71; 95% CI, 1.08 to 2.73). Frequent hemodialysis was associated with improved control of hypertension and hyperphosphatemia. There were no significant effects of frequent hemodialysis on cognitive performance, self-reported depression, serum albumin concentration, or use of erythropoiesis-stimulating agents. Frequent hemodialysis, as compared with conventional hemodialysis, was associated with favorable results with respect to the composite outcomes of death or change in left ventricular mass and death or change in a physical-health composite score but prompted more frequent interventions related to vascular access.