He Liyu, Fu Min, Chen Xian, Liu Hong, Chen Xing, Peng Xiaofei, Liu Fuyou, Peng Youming
Key Laboratory of Kidney Disease and Blood Purification in Hunan, Nephrology Department, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China.
Hemodial Int. 2015 Apr;19(2):263-9. doi: 10.1111/hdi.12215. Epub 2014 Sep 12.
Many studies found that hemoglobin (Hb) fluctuation was closely related to the prognosis of the maintenance hemodialysis patients. We investigated the association of factors relating dialysis dose and dialyzer membrane with Hb levels. We undertook a randomized clinical trial in 140 patients undergoing thrice-weekly dialysis and assigned patients randomly to a standard or high dose of dialysis; Hb level was measured every month for 12 months. In the standard-dose group, the mean (±SD) urea reduction ratio was 65.1% ± 7.3%, the single-pool Kt/V was 1.26 ± 0.11, and the equilibrated Kt/V was 1.05 ± 0.09; in the high-dose group, the values were 73.5% ± 8.7%, 1.68 ± 0.15, and 1.47 ± 0.11, respectively. The standard deviation (SD) and residual SD (liner regression of Hb) values of Hb were significantly higher in the standard-dose group and low-flux group. The percentage achievement of target Hb in the high-dose dialysis group and high-flux dialyzer group was significantly higher than the standard-dose group and low-flux group, respectively. Patients undergoing hemodialysis thrice weekly appear to have benefit from a higher dialysis dose than that recommended by current KDQQI (Kidney Disease Qutcome Quality Initiative) guidelines or from the use of a high-flux membrane, which is in favor of maintaining stable Hb levels.
许多研究发现，血红蛋白（Hb）波动与维持性血液透析患者的预后密切相关。我们调查了透析剂量和透析器膜相关因素与Hb水平的关联。我们对140例每周进行三次透析的患者进行了一项随机临床试验，并将患者随机分为标准剂量或高剂量透析组；连续12个月每月测量Hb水平。在标准剂量组中，平均（±标准差）尿素清除率为65.1%±7.3%，单池Kt/V为1.26±0.11，平衡Kt/V为1.05±0.09；在高剂量组中，这些值分别为73.5%±8.7%，1.68±0.15和1.47±0.11。标准剂量组和低通量组中Hb的标准差（SD）和残余SD（Hb的线性回归）值显著更高。高剂量透析组和高通量透析器组的目标Hb达标率分别显著高于标准剂量组和低通量组。每周进行三次血液透析的患者似乎从高于当前KDQQI（肾脏病预后质量倡议）指南推荐的透析剂量或使用高通量膜中获益，这有利于维持稳定的Hb水平。
