夜间家庭血液透析降低心血管相关住院率。

Reduction in cardiovascular related hospitalization with nocturnal home hemodialysis.

作者信息

Bergman A, Fenton S S A, Richardson R M A, Chan C T

机构信息

Department of Medicine, Division of Nephrology, The Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.

出版信息

Clin Nephrol. 2008 Jan;69(1):33-9. doi: 10.5414/cnp69033.

DOI:10.5414/cnp69033

PMID:18218314

Abstract

BACKGROUND

Cardiovascular disease remains the leading cause of death among patients with end-stage renal disease (ESRD). Nocturnal home hemodialysis (NHD) (5 - 6 sessions per week; 6 - 8 hours per session) is a novel form of home-based renal replacement therapy, which has been shown to improve several cardiovascular risk factors. The impact of NHD on hospitalization rate has remained unclear. We hypothesized that augmentation of small and middle molecular clearance by NHD would result in a reduction of dialysis related or cardiovascular specific hospitalizations.

METHODS AND RESULTS

In this controlled cohort study, we studied 32 NHD patients (age: 43 +/- 2 [mean +/- SEM]) 1 year before and 2 years after conversion to NHD and 42 CHD patients (mean age: 44 +/- 2) (matched for age, dialysis vintage and controlled for comorbidities) during the same time period. The primary outcome was the change in a composite of dialysis or cardiovascular related admissions rate before and after conversion to NHD. Secondary outcomes included changes in all cause hospitalization rate, visits to emergency, reasons and duration of hospitalization and dialysis-related biochemical parameters. During the study period, dialysis or cardiovascular-related admission rate was stable for the CHD control cohort (from 0.48 +/- 0.14 [baseline] to 0.40 +/- 0.12 [end of study] admission per patient year, p = NS). In contrast, conversion to NHD is associated with a decrease in our composite endpoint (from 0.50 +/- 0.15 to 0.17 +/- 0.06 admission per patient year, p = 0.04). Cardiovascular disease (37%) was the principal cause for hospitalization in the control population. In comparison, vascular access related admission was the primary cause of admission for the NHD cohort (56%), p = 0.001. Of the biochemical parameters, NHD is associated with a decrease in plasma phosphate (from 1.7 +/- 0.1 to 1.3 +/- 0.1 mM, p = 0.01) and an improved control of anemia (from 114 +/- 2 to 122 +/- 3 g/l, p = 0.02).

CONCLUSION

Conversion to NHD is associated with a decrease in dialysis and cardiovascular-related hospital admission. The clinical and mechanistic relevance in uremic patients of improved phosphate and anemia management requires further examination.

摘要

背景

心血管疾病仍是终末期肾病（ESRD）患者的主要死因。夜间家庭血液透析（NHD）（每周5 - 6次；每次6 - 8小时）是一种新型的家庭式肾脏替代治疗方式，已被证明可改善多种心血管危险因素。NHD对住院率的影响尚不清楚。我们推测，NHD增加中小分子清除率将导致透析相关或心血管特异性住院率降低。

方法与结果

在这项对照队列研究中，我们研究了32例NHD患者（年龄：43±2 [均值±标准误]）在转换为NHD前1年和转换后2年的情况，以及42例对照患者（平均年龄：44±2）（年龄、透析龄匹配且合并症得到控制）在同一时期的情况。主要结局是转换为NHD前后透析或心血管相关住院率的综合变化。次要结局包括全因住院率、急诊就诊次数、住院原因和时长以及透析相关生化参数的变化。在研究期间，对照队列中透析或心血管相关住院率保持稳定（从0.48±0.14 [基线]降至0.40±0.12 [研究结束时]每人每年住院次数，p = 无显著差异）。相比之下，转换为NHD与我们的综合终点降低相关（从0.50±0.15降至0.17±0.06每人每年住院次数，p = 0.04）。心血管疾病（37%）是对照人群住院的主要原因。相比之下，血管通路相关住院是NHD队列住院的主要原因（56%），p = 0.001。在生化参数方面，NHD与血浆磷酸盐降低相关（从1.7±0.1降至1.3±0.1 mM，p = 0.01）以及贫血控制改善（从114±2升至122±3 g/l，p = 0.02）。