Charra B, Calemard E, Ruffet M, Chazot C, Terrat J C, Vanel T, Laurent G
Centre de rein artificiel, Tassin, France.
Kidney Int. 1992 May;41(5):1286-91. doi: 10.1038/ki.1992.191.
To examine how patient survival substantiates dialysis adequacy, 20-year actuarial survival experience was calculated for 445 unselected hemodialysis (HD) patients (97 patients accepted on a temporary basis--and usually kept on their regular dialysis scheme--were left out). The dose of dialysis has been the same and unchanged for all patients since beginning: 24 square meter hours of Kiil dialysis (cuprophane) per week with acetate buffered dialysate. KT/V mean (SD) was 1.67 (0.41). Six months after starting dialysis, 98% of patients were normotensive and off all blood pressure (BP) medication. The mean population hematocrit, excluding the only 6 patients receiving erythropoietin supplementation, was 28%. Survival rate was 87% at 5 years, 75% at 10 years, 55% at 15 years, and 43% at 20 years of HD. The satisfactory control of BP without using potentially toxic BP drugs and the higher than usual dose of dialysis are two possible explanations for survival data better than usually reported. We suggest that patient survival should be considered as the best overall index of adequacy of dialysis.
为了研究患者生存率如何证实透析充分性，我们计算了445例未经挑选的血液透析（HD）患者的20年精算生存经验（97例临时接受治疗且通常维持常规透析方案的患者被排除）。自开始透析以来，所有患者的透析剂量相同且未变：每周进行24平方米小时的基尔透析（铜仿膜），使用醋酸盐缓冲透析液。KT/V均值（标准差）为1.67（0.41）。开始透析6个月后，98%的患者血压正常且停用了所有降压药物。排除仅6例接受促红细胞生成素补充治疗的患者后，总体平均血细胞比容为28%。血液透析5年时生存率为87%，10年时为75%，15年时为55%，20年时为43%。不使用潜在有毒的降压药物而实现的血压良好控制以及高于常规剂量的透析，是生存数据优于通常报道的两种可能解释。我们建议，患者生存率应被视为透析充分性的最佳总体指标。
