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Efficacy of Twice Weekly Hemodialysis in Patients with Residual Kidney Function

每周两次血液透析对残余肾功能患者的疗效

基本信息

批准号：
10413875
负责人：
Tammy Lisa Sirich
金额：
$ 31.6万
依托单位：
PALO ALTO VETERANS INSTIT FOR RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-05 至 2024-05-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY / ABSTRACT The dialysis population is growing rapidly, with more than 100,000 patients starting treatment every year. The great majority of these patients receive hemodialysis three times per week from the onset of therapy despite most having substantial residual function. While thrice weekly treatment remains standard, recent years have seen renewed interest in reducing treatment frequency for patients with residual native kidney function. It seems logical that if patients retain some kidney function, they do not need as much hemodialysis. Current guidelines indeed allow reduction in dialysis frequency to twice weekly based on residual function. However, fewer than 2% of patients receive hemodialysis twice weekly. There are two major reasons why twice weekly hemodialysis is prescribed so rarely. First, no controlled study has ever assessed the effect of prescribing twice weekly treatment using the current guidelines. The second impediment is the misconception that very long treatment times are required for twice weekly treatment. It is not widely appreciated that current 2015 guidelines reduced the dialysis dose for patients with residual kidney function so that treatment times for twice weekly hemodialysis are no longer dramatically high. The proposed study will be the first to compare the efficacy of twice weekly and thrice weekly hemodialysis in patients with residual function. It will employ a cross-over design consisting of two 4-week periods. During one period, treatment will be provided twice weekly with residual kidney function incorporated into the prescription as specified by the current guidelines. During the other period, treatment will be provided thrice weekly regardless of the residual kidney function as is the current common practice. The first aim is to assess the effect of twice weekly hemodialysis on quality of life. We will test the hypothesis that quality of life is not impaired by a change from the current practice of prescribing thrice weekly dialysis without regard to residual function to prescribing twice weekly dialysis incorporating residual kidney function as specified by the guidelines. The second aim is to assess the effect of twice weekly hemodialysis on plasma levels of uremic solutes, which are normally cleared by secretion. It will test the hypothesis that levels of these secreted solutes are only minimally increased by a change from the current practice of prescribing thrice weekly dialysis without regard to residual function to prescribing twice weekly dialysis incorporating residual function. The 2015 guidelines acknowledged that the remnant kidney performs valuable functions which are not reflected by the removal of urea, the current marker solute. One such function is solute secretion, which is preserved in the remnant kidney and not replicated by hemodialysis. Positive results from the proposed study would encourage increased prescription of twice weekly hemodialysis when sufficient residual function is present. This shift would reduce the burden and cost of treatment. Overall results of the proposed study would provide a foundation for future trials of twice weekly hemodialysis.

项目概要/摘要透析人群快速增长，每年有超过10万名患者开始治疗年。这些患者中的绝大多数从治疗开始后每周接受三次血液透析尽管大多数具有显着的残余功能。虽然每周三次治疗仍然是标准治疗，但最近多年来，人们对减少残余肾患者的治疗频率重新产生了兴趣功能。如果患者保留一些肾功能，他们就不需要那么多的血液透析，这似乎是合乎逻辑的。目前的指南确实允许根据残余功能将透析频率减少到每周两次。然而，只有不到 2% 的患者每周接受两次血液透析。有两个主要原因每周两次血液透析的情况很少见。首先，没有对照研究评估过使用现行指南每周进行两次治疗。第二个障碍是错误的观念每周两次治疗需要很长的治疗时间。目前还没有被广泛认识到 2015年指南减少了残余肾功能患者的透析剂量，从而缩短了治疗时间每周两次血液透析的比例不再高得惊人。拟议的研究将是第一个比较每周两次和每周三次血液透析对残余功能患者的疗效。它将雇用一个交叉设计由两个为期 4 周的周期组成。一个时期内，将提供两次治疗每周一次，将残余肾功能纳入当前指南规定的处方中。在其他时期，无论残余肾功能如何，每周都会提供三次治疗目前的常见做法。第一个目标是评估每周两次血液透析对生活质量的影响。我们将测试假设当前每周三次处方的改变不会损害生活质量不考虑残余功能的透析每周两次透析，包括残余肾按照指南的规定发挥作用。第二个目的是评估每周两次血液透析的效果尿毒症溶质的血浆水平，通常通过分泌物清除。它将检验以下假设：通过改变当前的实践，这些分泌的溶质的水平仅略有增加不考虑残余功能而每周进行三次透析每周进行两次透析结合残差函数。 2015 年指南承认残肾具有重要价值去除目前的标记溶质尿素无法反映这些功能。溶质就是这样一个函数分泌物，保留在残肾中，并且不能通过血液透析复制。积极的结果来自拟议的研究将鼓励在足够的情况下增加每周两次血液透析的处方存在残差函数。这种转变将减轻治疗的负担和费用。总体结果拟议的研究将为未来每周两次血液透析的试验奠定基础。