Wong Joseph H S, Pierratos Andreas, Oreopoulos Dimitrios G, Mohammad Reem, Benjamin-Wong Fatima, Chan Christopher T
Division of Nephrology, Queen Elizabeth Hospital, Hong Kong, China.
Perit Dial Int. 2007 Nov-Dec;27(6):669-74.
Failure of peritoneal dialysis (PD) results in poor quality of life and worsening morbidity in patients with end-stage renal disease (ESRD). Traditionally, hospital-based conventional hemodialysis has been the only option for this patient population. We hypothesized that nocturnal home hemodialysis (NHD), 3-6 sessions per week, 6-8 hours per session, is a suitable alternative salvage therapy for this vulnerable patient group.
This is a descriptive cohort study of all consecutive ESRD patients failing PD that were converted to NHD at the University Health Network and Humber River Regional Hospital from 2003 to 2005. Our primary objective was to describe the changes in clinical and biochemical indices before and after conversion from PD to NHD.
69 patients required transfer from PD to another form of renal replacement therapy during the period of interest. Our pilot cohort included 8 ESRD patients (5 males, 3 females; age 53 +/- 7 years). Mean duration on PD was 4.8 +/- 4.6 years. NHD delivered a higher dose of dialysis, as reflected by lower plasma creatinine concentration 1 year after beginning NHD (from 1107 +/- 312 micromol/L with PD to 649 +/- 309 micromol/L, p = 0.01) and a rise in standardized Kt/V (from 2.21 +/- 0.73 with PD to 4.49 +/- 1.92 after 6 months of NHD, to 4.51 +/- 1.77 after 1 year of NHD; p < 0.001). There was a progressive and sustained rise in plasma albumin after conversion to NHD (from 31 +/- 4 g/L with PD to 36 +/- 4 g/L after 6 months of NHD, to 39 +/- 2 g/L after 1 year of NHD; p = 0.001). Hemoglobin concentrations increased (from 102 +/- 13 to 125 +/- 7 g/L, p = 0.03), while erythropoietin requirement tended to fall (from 17500 +/- 8669 to 9197 +/- 7573 U/week). Plasma phosphate fell (from 2.1 +/- 0.6 to 1.1 +/- 0.3 mmol/L, p = 0.01) despite a decrease in phosphate binder requirement. Blood pressure profile also tended to improve after conversion to NHD.
Nocturnal HD represents a promising, viable, alternative renal replacement therapy for patients experiencing PD failure. The clinical impact of transferring ESRD patients failing PD to NHD deserves further investigation.
腹膜透析（PD）失败会导致终末期肾病（ESRD）患者生活质量下降和发病率恶化。传统上，基于医院的常规血液透析一直是这一患者群体的唯一选择。我们推测，每周进行3 - 6次、每次6 - 8小时的夜间家庭血液透析（NHD）是适合这一脆弱患者群体的替代挽救治疗方法。
这是一项描述性队列研究，研究对象为2003年至2005年在大学健康网络和亨伯河地区医院从PD转为NHD的所有连续性ESRD且PD失败的患者。我们的主要目的是描述从PD转为NHD前后临床和生化指标的变化。
在感兴趣的时间段内，69例患者需要从PD转为另一种肾脏替代治疗形式。我们的试点队列包括8例ESRD患者（5例男性，3例女性；年龄53±7岁）。PD的平均持续时间为4.8±4.6年。NHD提供了更高剂量的透析，这表现为开始NHD 1年后血浆肌酐浓度降低（从PD时的1107±312μmol/L降至649±309μmol/L，p = 0.01）以及标准化Kt/V升高（从PD时的2.21±0.73在NHD 6个月后升至4.49±1.92，在NHD 1年后升至4.51±1.77；p < 0.001）。转为NHD后血浆白蛋白持续逐步升高（从PD时的31±4g/L在NHD 6个月后升至36±4g/L，在NHD 1年后升至39±2g/L；p = 0.001）。血红蛋白浓度增加（从102±13升至125±7g/L，p = 0.03），而促红细胞生成素需求趋于下降（从17500±8669降至9197±7573U/周）。尽管磷酸盐结合剂需求减少，但血浆磷酸盐仍下降（从2.1±0.6降至1.1±0.3mmol/L，p = 0.01）。转为NHD后血压情况也趋于改善。
夜间血液透析是经历PD失败患者的一种有前景、可行的替代肾脏替代治疗方法。将PD失败的ESRD患者转为NHD的临床影响值得进一步研究。
