Achinger Steven G, Ikizler T Alp, Bian Aihua, Shintani Ayumi, Ayus Juan Carlos
Department of Nephrology, Watson Clinic, LLP-Lakeland, FL, USA.
Hemodial Int. 2013 Apr;17(2):208-15. doi: 10.1111/j.1542-4758.2012.00756.x. Epub 2012 Sep 28.
Daily hemodialysis has been associated with surrogate markers of improved survival among hemodialysis patients. A potential disadvantage of daily hemodialysis is that frequent vascular access cannulations may affect long-term vascular access patency. The study design was a 4-year, nonrandomized, contemporary control, prospective study of 77 subjects in either 3-h daily hemodialysis (six 3-h dialysis treatments weekly; n = 26) or conventional dialysis (three 4-h dialysis treatments weekly; n = 51). Outcomes of interest were vascular access procedures (fistulagram, thrombectomy and access revision). Total access procedures (fistulagram, thrombectomy and access revision) were 543.2 (95% confidence interval [CI]: 432.9, 673.0) per 1000 person-years in the conventional dialysis group vs. 400.8 (95% CI: 270.2, 572.4) per 1000 person-years in the daily hemodialysis dialysis group (incidence rate ratio = 0.74 with 95% CI: from 0.40 to 1.36, P = 0.33), after adjusting for age, gender, diabetes status, serum phosphorus, hemoglobin level and erythropoietin dose, there was no significant differences in incidence rate of total access procedures (P-value > 0.05). There was no difference in time to first access revision between the daily dialysis and the conventional dialysis groups after adjustment for covariates (hazard ratio = 0.99 95% CI: 0.42, 2.36, P = 0.96). Daily hemodialysis is not associated with increased vascular access complications, or increased vascular access failure rates.
每日血液透析与血液透析患者生存率提高的替代指标相关。每日血液透析的一个潜在缺点是频繁的血管通路插管可能会影响长期血管通路的通畅性。该研究设计为一项为期4年的非随机、当代对照前瞻性研究，共纳入77名受试者，其中26名接受每日3小时血液透析（每周6次3小时透析治疗），51名接受传统透析（每周3次4小时透析治疗）。感兴趣的结局是血管通路手术（血管造影、血栓切除术和通路修复）。传统透析组每1000人年的总通路手术（血管造影、血栓切除术和通路修复）为543.2次（95%置信区间[CI]：432.9，673.0），而每日血液透析组为400.8次（95%CI：270.2，572.4）（发病率比=0.74，95%CI：0.40至1.36，P=0.33）。在调整年龄、性别、糖尿病状态、血清磷、血红蛋白水平和促红细胞生成素剂量后，总通路手术的发病率无显著差异（P值>0.05）。在调整协变量后，每日透析组和传统透析组首次通路修复的时间没有差异（风险比=0.99，95%CI：0.42，2.36，P=0.96）。每日血液透析与血管通路并发症增加或血管通路失败率增加无关。
