Williams Amy W, Chebrolu Srivasa B, Ing Todd S, Ting George, Blagg Christopher R, Twardowski Zbylut J, Woredekal Yalem, Delano Barbara, Gandhi Vasant C, Kjellstrand Carl M
Mayo Clinic, Rochester, MN 55905, USA.
Am J Kidney Dis. 2004 Jan;43(1):90-102. doi: 10.1053/j.ajkd.2003.09.017.
Advantages associated with an increased frequency of hemodialysis have been reported previously. However, previous studies were either small or not controlled and did not detail early clinical, biochemical, quality-of-life, urea kinetic, and dynamic changes when patients switched from a conventional (3 times/wk) dialysis regimen to "daily" (6 times/wk) dialysis therapy when total weekly dialysis time was unchanged.
A prospective sequential study with 21 patients as their own controls was performed. A 4-week period of conventional thrice-weekly dialysis (N = 240 treatments) was followed immediately by a 4-week period of daily (ie, 6 times/wk) dialysis (N = 480 treatments), in which each treatment was half the length of a conventional dialysis treatment session. Clinical parameters and symptoms during and between dialysis treatments were graded, and urea-related parameters, blood chemistry results, and nutritional data were determined.
Within 4 weeks of switching to this daily dialysis regimen, there were improvements in blood pressure, dialysis "unphysiology," intradialytic and interdialytic symptoms, and urea kinetics and dynamics. There were fewer machine alarms and less need for nursing interventions during dialysis. Nutrition and quality of life began to improve. There was no increase in blood access complications and no significant changes in blood chemistry results, hematologic parameters, or use of medications.
In this short-term study, daily dialysis appears to be a safe, better, and more physiological method to deliver dialysis care to patients with end-stage renal disease.
先前已有报道增加血液透析频率的相关益处。然而，既往研究样本量小或缺乏对照，且未详细说明当患者从传统的（每周3次）透析方案转换为“每日”（每周6次）透析治疗（每周总透析时间不变）时的早期临床、生化、生活质量、尿素动力学及动态变化情况。
进行了一项前瞻性序贯研究，21例患者自身作为对照。先进行为期4周的传统每周3次透析（共240次治疗），随后紧接着进行为期4周的每日（即每周6次）透析（共480次治疗），其中每次治疗时长为传统透析治疗时长的一半。对透析治疗期间及两次透析之间的临床参数和症状进行分级，并测定与尿素相关的参数、血液化学检查结果及营养数据。
转换为每日透析方案后的4周内，血压、透析“非生理性”、透析期间及透析间期症状、尿素动力学及动态均有改善。透析期间机器报警减少，护理干预需求降低。营养状况及生活质量开始改善。血液通路并发症未增加，血液化学检查结果、血液学参数或药物使用情况无显著变化。
在这项短期研究中，每日透析似乎是为终末期肾病患者提供透析治疗的一种安全、更好且更符合生理的方法。
