Poon Clara K Y, Tang Hon-Lok, Wong Joseph H S, Law Wai-Ping, Lam Chung-Man, Yim Ka-Fai, Cheuk Au, Lee William, Chau Ka-Foon, Tong Matthew K L, Fung Samuel K S
Division of Nephrology, Jockey Club Nephrology and Urology Centre, Princess Margaret Hospital, Hong Kong, Hongkong.
Hemodial Int. 2015 Apr;19(2):235-41. doi: 10.1111/hdi.12227. Epub 2014 Sep 23.
Nocturnal home hemodialysis (NHHD) has shown promising results in various clinical parameters. Whether NHHD provide benefit in anemia management remains controversial. This study aims to investigate whether anemia and erythropoiesis-stimulating agent (ESA) requirement are improved in patients receiving alternate night NHHD compared with conventional hemodialysis (CHD). In this retrospective controlled study, a clinical data of 23 patients receiving NHHD were compared with 25 in-center CHD patients. Hemoglobin level, ESA requirement, iron profile, and dialysis adequacy indexes were compared between the two groups. Hemoglobin level increased from baseline of 9.37 ± 1.39 g/dL to 11.34 ± 2.41 g/dL at 24 months (P < 0.001) and ESA requirement decreased from 103.44 ± 53.55 U/kg/week to 47.33 ± 50.62 U/kg/week (P < 0.001) in NHHD patients. ESA requirement further reduced after the first year of NHHD (P = 0.037). Standard Kt/V increased from baseline of 2.02 ± 0.28 to 3.52 ± 0.30 at 24 months (P < 0.001). At 24 months, hemoglobin level increased by 1.98 ± 2.74 g/dL in the NHHD group while it decreased by 0.20 ± 2.32 g/dL in the CHD group (P = 0.007). ESA requirement decreased by 53.49 ± 55.50 U/kg/week in NHHD patients whereas it increased by 16.22 ± 50.01 U/kg/week in CHD patients (P < 0.001). Twenty-six percent of NHHD patients were able to stop ESA compared with none in the CHD group. Standard Kt/V showed greater increase in the NHHD group. (1.49 ± 0.36 in NHHD vs. 0.18 ± 0.31 in CHD, P = 0.005). NHHD with an alternate night schedule improves anemia and reduces ESA requirement as a result of enhanced uremic clearance. This benefit extended beyond the first year of NHHD.
夜间家庭血液透析（NHHD）在各项临床指标上已显示出有前景的结果。NHHD在贫血管理方面是否有益仍存在争议。本研究旨在调查与传统血液透析（CHD）相比，接受隔日夜间NHHD的患者在贫血和促红细胞生成素（ESA）需求方面是否得到改善。在这项回顾性对照研究中，将23例接受NHHD的患者的临床数据与25例中心CHD患者的数据进行了比较。比较了两组之间的血红蛋白水平、ESA需求、铁指标和透析充分性指标。NHHD患者的血红蛋白水平从基线的9.37±1.39g/dL在24个月时升至11.34±2.41g/dL（P<0.001），ESA需求从103.44±53.55U/kg/周降至47.33±50.62U/kg/周（P<0.001）。NHHD治疗一年后ESA需求进一步降低（P=0.037）。标准Kt/V从基线的2.02±0.28在24个月时升至3.52±0.30（P<0.001）。在24个月时，NHHD组的血红蛋白水平升高了1.98±2.74g/dL，而CHD组降低了0.20±2.32g/dL（P=0.007）。NHHD患者的ESA需求降低了53.49±55.50U/kg/周，而CHD患者增加了16.22±50.01U/kg/周（P<0.001）。26%的NHHD患者能够停用ESA，而CHD组无一人能停用。标准Kt/V在NHHD组升高得更多。（NHHD组为1.49±0.36，CHD组为0.18±0.31，P=0.005）。隔日夜间进行的NHHD由于增强了尿毒症清除率，改善了贫血并降低了ESA需求。这种益处持续超过了NHHD治疗的第一年。
