Goldsmith David
Renal Unit, Guy's Hospital, London, UK.
Blood Purif. 2008;26(1):63-6. doi: 10.1159/000110567. Epub 2008 Jan 10.
The mortality rates which we have seen now over several decades of routine provision of renal replacement therapy are truly remarkable - even if, with time, we have become familiar, if not comfortable, with them. The remarkable nature of this mortality issue is its severity, and persistence, despite numerous efforts to combat it with 'active interventions'. These have included, in no particular order, correction of anaemia, better provision of dialysis adequacy, use of more permeable dialysis membranes, better control of dyslipidaemia, better control of mineral and bone metabolic parameters, correction of hyperhomocysteinaemia, and use of ACE inhibitors. One can now in 2008 be forgiven for some pessimism, nihilism (sometimes known as 'renalism') about the prospects for useful prolongation of life on dialysis except of course by transplantation. In this article (a fuller version of which appears also in Nephrology Dialysis and Transplantation, I discuss the reasons for the failure of the trials to date, the likely obstacles to future trials succeeding, and some suggestions for alternative strategies to try to grapple with this immense burden of vascular and all-cause morbidity and mortality.
在过去几十年常规提供肾脏替代治疗的过程中，我们所看到的死亡率确实相当惊人——即便随着时间推移，我们就算谈不上心安理得，至少也已对这些死亡率习以为常。这一死亡率问题的惊人之处在于，尽管人们采取了诸多“积极干预措施”来应对它，但其严重性和持续性依旧存在。这些措施包括（此处无特定顺序）纠正贫血、更好地确保透析充分性、使用通透性更高的透析膜、更好地控制血脂异常、更好地控制矿物质和骨代谢参数、纠正高同型半胱氨酸血症以及使用血管紧张素转换酶抑制剂。到了2008年，对于除移植外通过透析有效延长生命的前景抱有某种悲观情绪、虚无主义态度（有时被称为“肾脏主义”）是情有可原的。在本文中（其完整版本亦发表于《肾脏病透析与移植》），我探讨了迄今试验失败的原因、未来试验成功可能面临的障碍，以及一些关于替代策略的建议，试图应对这一由血管疾病和全因发病率及死亡率所构成的巨大负担。
