Lindsay Robert M, Leitch Rosemary, Heidenheim A Paul, Kortas Claude
The Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Am J Kidney Dis. 2003 Jul;42(1 Suppl):5-12. doi: 10.1016/s0272-6386(03)00531-6.
Despite the growing interest in more frequent hemodialysis (HD), to date, there have been no randomized prospective studies comparing outcomes in patients dialyzed using conventional thrice-weekly therapy with either the short hours daily or long slow nocturnal HD modalities.
The London Daily/Nocturnal Hemodialysis Study, a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian HD patients with conventional thrice-weekly HD patients. Patients were assigned to either daily HD (n = 11) or nocturnal HD (n = 12) and followed up for 5 to 36 months; all data were directly compared with matched control patients receiving conventional HD. This report describes the study design, morbidity and mortality results, and vascular access results.
There were no significant differences between patient groups in total numbers of hospital admissions or hospital days. Likewise, there was no significant difference in number of emergency visits per patient-year. There were 3 patient deaths in each of the nocturnal HD and control groups, although none of the deaths was deemed related to HD treatment. No deaths occurred in the daily HD group. Vascular access differences between study groups were not statistically significant. Among patients with arteriovenous (AV) fistulae, more than 80% of daily HD and nocturnal HD patients elected to use the buttonhole technique and successfully performed quotidian HD through their buttonhole at the 18-month follow-up. Patients with AV fistulae had the lowest annual rates of access complications and interventions. The annual access infection rate for quotidian HD patients using catheters decreased significantly after patients switched from in-center conventional HD to more frequent HD treatments at home.
Results from this comprehensive and pioneering study support the hypothesis that quotidian HD is more physiological than conventional HD and results in better patient outcomes.
尽管人们对更频繁的血液透析（HD）兴趣日增，但迄今为止，尚无随机前瞻性研究比较采用传统每周三次疗法进行透析的患者与每日短时间或长时间夜间HD模式的患者的结局。
伦敦每日/夜间血液透析研究是一项前瞻性、比较性、非随机研究，直接比较了每日HD患者与传统每周三次HD患者的结局。患者被分配至每日HD组（n = 11）或夜间HD组（n = 12），并随访5至36个月；所有数据均与接受传统HD的匹配对照患者直接比较。本报告描述了研究设计、发病率和死亡率结果以及血管通路结果。
各患者组之间的住院总次数或住院天数无显著差异。同样，每位患者每年的急诊就诊次数也无显著差异。夜间HD组和对照组各有3例患者死亡，尽管这些死亡均被认为与HD治疗无关。每日HD组未发生死亡。研究组之间的血管通路差异无统计学意义。在动静脉（AV）内瘘患者中，超过80%的每日HD和夜间HD患者选择使用纽扣式穿刺技术，并在18个月随访时通过其纽扣式穿刺成功进行每日HD。AV内瘘患者的血管通路并发症和干预年发生率最低。每日HD患者使用导管时，在患者从中心常规HD转为在家中更频繁的HD治疗后，其每年的血管通路感染率显著降低。
这项全面且开创性研究的结果支持了以下假设，即每日HD比传统HD更符合生理需求，并能带来更好的患者结局。
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