Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients
Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients
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DOI：
10.1093/ndt/17.10.1814
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发表时间：
2002-10-01
影响因子：
6.1
通讯作者：
Fischer, R
中科院分区：
文献类型：
--
作者：
Schiffl, H;Lang, SM;Fischer, R
背景。残余肾功能有利于血液透析的充分性、透析患者的生活质量和死亡率。我们的前瞻性随机研究旨在分析透析液微生物质量对开始血液透析后残余肾功能过程的影响。方法。三十名开始血液透析的患者被随机分配至超纯透析液或传统透析液。在 24 个月的研究期间，每 6 个月评估一次肌酐清除率、CRP 和 IL-6 水平、水合状态、低血压发作次数和血压记录。结果。在研究期间，两组的残余肾功能均下降，尽管招募时的人口统计学（年龄、性别）、肾脏（终末期肾病的原因、残余肾功能、高血压、ACE抑制剂）和治疗特征（Kt/V尿素）没有统计学上的显着差异。使用轻度污染（高达 300 CFU/ml）的透析液会导致较高的 CRP 和 IL-6 水平以及更明显的残余肾功能丧失。多元回归分析表明，透析液的微生物质量是残余肾功能丧失的独立决定因素。结论。超纯透析液与高通量合成膜相结合是肾脏替代疗法的有效组成部分，可减缓血液透析患者残余肾功能的丧失。血液透析的这些改进是可取的，但增加了治疗成本。
Background. Residual renal function is beneficial for adequacy of haemodialysis, quality of life and mortality in dialysis patients. Our prospective randomised investigation aimed to analyse the effects of the microbiological quality of dialysis fluid on the course of residual renal function after initiation of haemodialysis.Methods. Thirty patients starting haemodialysis were randomly assigned to ultrapure or conventional dialysate. During the 24-month study period, creatinine clearance, CRP and IL-6 levels, hydration status, number of hypotensive episodes and blood pressure recordings were assessed every 6 months.Results. Residual renal function declined in both groups during the study period, although there were no statistically significant differences in demographic (age, gender), renal (cause of end-stage renal disease, residual renal function, hypertension, ACE inhibitors) and treatment characteristics (Kt/V urea) at recruitment. The use of mildly contaminated (up to 300 CFU/ml) dialysate resulted in higher CRP and IL-6 levels and more pronounced loss of residual renal function. Multiple regression analysis showed that the microbiological quality of the dialysate is an independent determinant of the loss of residual renal function.Conclusions. Ultrapure dialysis fluid combined with high-flux synthetic membranes are effective components of renal replacement therapy to slow the loss of residual renal function in haemodialysis patients. These improvements of haemodialysis are desirable, but add to treatment costs.