Division of Nephrology, Fresenius Medical Care Turkey Clinics, Izmir, Turkey.
Am J Nephrol. 2013;37(6):559-67. doi: 10.1159/000351182. Epub 2013 May 30.
This prospective cohort study compared the changes in body water composition and nutritional parameters measured with multifrequency bioimpedance analysis between 8-hour three times weekly nocturnal hemodialysis (NHD) and 4-hour conventional hemodialysis (CHD) patients.
55 patients on CHD and 57 patients on NHD were included in the study. Multifrequency bioimpedance analysis was performed at baseline and at the 12th month. The primary outcomes of the study were changes in extracellular water (ECW), fat mass, dry lean mass and phase angle. Secondary outcomes of the study included changes in blood pressure and biochemical parameters related to nutrition and inflammation.
ECW/height values decreased in the NHD group, while they increased in the CHD group. Fat mass, dry lean mass, and serum albumin increased and high sensitive CRP decreased in the NHD group but did not change in the CHD group. When changes in parameters from baseline to the 12th month between the groups were compared, NHD was associated with improvement in volume parameter including ECW/height (difference -0.44 l/m, p < 0.001). Change in blood pressure was not different between the groups, however requirement for antihypertensive medication decreased from 26.5 to 8.5% in the NHD group (p = 0.002). NHD was also associated with increases in fat mass (difference 1.8 kg, p < 0.001), dry lean mass (difference 0.6 kg, p = 0.006), serum albumin (difference 0.19 g/dl, p < 0.001) and cholesterol (difference 18.8 mg, p < 0.001). Phase angle values decreased in the CHD group but did not change in the NHD group (difference between the groups 0.37°, p = 0.04).
This study revealed that longer HD facilitates volume control and improves nutritional status.
本前瞻性队列研究比较了 8 小时 3 次/周夜间血液透析（NHD）和 4 小时常规血液透析（CHD）患者的多频生物阻抗分析测量的体水成分和营养参数的变化。
本研究纳入了 55 例 CHD 患者和 57 例 NHD 患者。多频生物阻抗分析在基线和第 12 个月进行。研究的主要结局是细胞外液（ECW）、脂肪量、干瘦体重和相位角的变化。研究的次要结局包括血压和与营养和炎症相关的生化参数的变化。
NHD 组 ECW/身高值降低，而 CHD 组升高。NHD 组的脂肪量、干瘦体重和血清白蛋白增加，高敏 C 反应蛋白降低，但 CHD 组无变化。比较两组从基线到第 12 个月参数变化时，NHD 与包括 ECW/身高在内的容量参数的改善相关（差值-0.44 l/m，p<0.001）。两组间血压变化无差异，但 NHD 组的降压药物需求从 26.5%降至 8.5%（p=0.002）。NHD 还与脂肪量增加（差值 1.8 公斤，p<0.001）、干瘦体重增加（差值 0.6 公斤，p=0.006）、血清白蛋白增加（差值 0.19 克/分升，p<0.001）和胆固醇增加（差值 18.8 毫克，p<0.001）相关。CHD 组的相位角值降低，但 NHD 组无变化（两组间差值 0.37°，p=0.04）。
本研究表明，较长时间的血液透析有助于控制容量并改善营养状况。
