Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy.
Twice-weekly and incremental hemodialysis treatment for initiation of kidney replacement therapy.
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DOI：
10.1053/j.ajkd.2014.04.019
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Goldfarb DS
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh K;Unruh M;Zager PG;Kovesdy CP;Bargman JM;Chen J;Sankarasubbaiyan S;Shah G;Golper T;Sherman RA;Goldfarb DS
维持性血液透析（HD）的前几个月死亡率最高。在许多西方国家，过渡到肾脏替代治疗的患者通常开始每周三次HD，无论其残余肾功能（RKF）水平如何。RKF是生存率的主要预测因子。每周三次HD治疗次数越多，RKF下降越快，与透析溶质清除需求降低相关，并且是腹膜透析处方的重要因素。在本文中，我们回顾了增量HD的概念，其中每周透析剂量，特别是HD治疗频率，是基于各种临床因素，如RKF（包括尿量>0.5 L/天），容量状态，心血管症状，体型，钾和磷水平，营养状态，血红蛋白，共病状况，住院治疗和健康相关的生活质量。这10个临床标准可以确定哪些患者可能从开始每周两次维持HD中获益。定期监测这些标准将确定增加透析剂量和频率的时间。我们认识到，每周两次的HD代表了许多临床医生和司法管辖区的重大范式转变。因此，我们建议进行每周两次与每周三次HD的随机对照试验，以评估每周两次HD改善生存率和健康相关生活质量的潜力，同时降低成本，保护脆弱的血管通路，并优化资源利用。这种增量和个体化HD治疗可能被证明是过渡到透析治疗的最合适方法。
Mortality is highest in the first months of maintenance hemodialysis (HD). In many Western countries, patients who transition to kidney replacement therapy usually begin thrice-weekly HD regardless of their level of residual kidney function (RKF). RKF is a major predictor of survival. RKF may decline more rapidly with more thrice-weekly HD treatments, is associated with a reduced need for dialytic solute clearance, and is an important factor in the prescription of peritoneal dialysis. In this paper we review the concept of incremental HD, in which weekly dialysis dose, in particular HD treatment frequency, is based on a variety of clinical factors such as RKF (including urine output >0.5 L/day), volume status, cardiovascular symptoms, body size, potassium and phosphorus levels, nutritional status, hemoglobin, comorbid conditions, hospitalizations, and health related quality of life. These ten clinical criteria may identify which patients might benefit from beginning maintenance HD twice-weekly. Periodic monitoring of these criteria will determine the timing for increasing dialysis dose and frequency. We recognize that twice-weekly HD represents a major paradigm shift for many clinicians and jurisdictions. Therefore, we propose conducting randomized controlled trials of twice-weekly vs. thrice-weekly HD to assess the potential of twice-weekly HD to improve survival and health related quality of life while simultaneously reducing costs, protecting fragile vascular accesses, and optimizing resource use. Such incremental and individualized HD therapy may prove to be the most appropriate approach for transitioning to dialytic therapy.
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