KfH Nierenzentrum München-Laim, Elsenheimerstr. 63, 80687, Munich, Germany,
Int Urol Nephrol. 2013 Oct;45(5):1389-96. doi: 10.1007/s11255-012-0336-4. Epub 2012 Dec 7.
Residual renal function (RRF) contributes to dialysis adequacy, quality of life and survival of hemodialysis patients. There is an ongoing debate whether better preservation of residual renal function is the result of chronic fluid volume overload. Our prospective investigation analyzed the effects of different dialytic therapies on RRF and left ventricular hypertrophy, which may be considered--at least in part--a surrogate marker of chronic fluid overload.
Two cohorts of end-stage renal disease patients initiating renal replacement therapy (high efficiency post-dilution on-line hemodiafiltration (HDF) in 58 patients, conventional hemodialysis (HD) in 60 patients) were prospectively followed up. RRF was determined at baseline, 12 and 24 months, left ventricular mass index (LVMI) at baseline and after 24 months.
Demographic and renal characteristics, medication or exposure to nephrotoxins were comparable among the two cohorts of patients. RRF declined in all patients throughout the 2-year study period. In HDF patients, the decline was less pronounced (28 %) than in conventional HD patients (68 %). More patients undergoing HD received cardio- and renoprotective antihypertensive drugs. CRP levels were significantly higher in conventional HD. Hypotensive episodes were fewer in HDF. LVMI decreased in 90 % of HDF compared to only 25 %of HD patients.
Our data clearly indicate that better preservation of RRF by high efficiency hemodiafiltration is not associated with left ventricular hypertrophy.
残余肾功能（RRF）有助于透析充分性、生活质量和血液透析患者的生存。目前仍存在争议，即 RRF 的更好保留是否是慢性液体容量超负荷的结果。我们的前瞻性研究分析了不同透析治疗对 RRF 和左心室肥厚的影响，左心室肥厚可以被认为是（至少部分是）慢性液体超负荷的替代标志物。
前瞻性随访了两组开始肾脏替代治疗的终末期肾病患者（58 例患者接受高效后稀释在线血液透析滤过（HDF），60 例患者接受常规血液透析（HD））。在基线、12 个月和 24 个月时测定 RRF，在基线和 24 个月时测定左心室质量指数（LVMI）。
两组患者的人口统计学和肾脏特征、药物或暴露于肾毒物相似。在整个 2 年的研究期间，所有患者的 RRF 均下降。在 HDF 患者中，下降幅度较小（28%），而在常规 HD 患者中下降幅度较大（68%）。更多接受 HD 的患者接受了心脏和肾脏保护的降压药物。常规 HD 患者的 CRP 水平显著升高。HDF 中低血压发作较少。与仅 25%的 HD 患者相比，90%的 HDF 患者的 LVMI 降低。
我们的数据清楚地表明，高效血液透析滤过对 RRF 的更好保留与左心室肥厚无关。
