Saran R, Bragg-Gresham J L, Levin N W, Twardowski Z J, Wizemann V, Saito A, Kimata N, Gillespie B W, Combe C, Bommer J, Akiba T, Mapes D L, Young E W, Port F K
Division of Nephrology and Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan 48103-4262, USA.
Kidney Int. 2006 Apr;69(7):1222-8. doi: 10.1038/sj.ki.5000186.
Longer treatment time (TT) and slower ultrafiltration rate (UFR) are considered advantageous for hemodialysis (HD) patients. The study included 22,000 HD patients from seven countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Logistic regression was used to study predictors of TT > 240 min and UFR > 10 ml/h/kg bodyweight. Cox regression was used for survival analyses. Statistical adjustments were made for patient demographics, comorbidities, dose of dialysis (Kt/V), and body size. Europe and Japan had significantly longer (P < 0.0001) average TT than the US (232 and 244 min vs 211 in DOPPS I; 235 and 240 min vs 221 in DOPPS II). Kt/V increased concomitantly with TT in all three regions with the largest absolute difference observed in Japan. TT > 240 min was independently associated with significantly lower relative risk (RR) of mortality (RR = 0.81; P = 0.0005). Every 30 min longer on HD was associated with a 7% lower RR of mortality (RR = 0.93; P < 0.0001). The RR reduction with longer TT was greatest in Japan. A synergistic interaction occurred between Kt/V and TT (P = 0.007) toward mortality reduction. UFR > 10 ml/h/kg was associated with higher odds of intradialytic hypotension (odds ratio = 1.30; P = 0.045) and a higher risk of mortality (RR = 1.09; P = 0.02). Longer TT and higher Kt/V were independently as well as synergistically associated with lower mortality. Rapid UFR during HD was also associated with higher mortality risk. These results warrant a randomized clinical trial of longer dialysis sessions in thrice-weekly HD.
更长的治疗时间（TT）和更低的超滤率（UFR）被认为对血液透析（HD）患者有利。该研究纳入了来自透析结果和实践模式研究（DOPPS）中七个国家的22000名HD患者。采用逻辑回归研究TT>240分钟和UFR>10毫升/小时/千克体重的预测因素。采用Cox回归进行生存分析。对患者的人口统计学、合并症、透析剂量（Kt/V）和体型进行了统计调整。欧洲和日本的平均TT显著长于美国（DOPPS I中分别为232分钟和244分钟，而美国为211分钟；DOPPS II中分别为235分钟和240分钟，而美国为221分钟，P<0.0001）。在所有三个地区，Kt/V均随TT同步增加，其中日本的绝对差异最大。TT>240分钟与显著更低的死亡相对风险（RR）独立相关（RR=0.81；P=0.0005）。HD每延长30分钟，死亡RR降低7%（RR=0.93；P<0.0001）。TT延长导致的RR降低在日本最为显著。Kt/V和TT之间存在协同作用（P=0.007），可降低死亡率。UFR>10毫升/小时/千克与透析中低血压的较高几率（优势比=1.30；P=0.045）和较高的死亡风险（RR=1.09；P=0.02）相关。更长的TT和更高的Kt/V与更低的死亡率独立相关且存在协同作用。HD期间快速的UFR也与更高的死亡风险相关。这些结果为每周三次HD中延长透析疗程的随机临床试验提供了依据。
