Đurić Petar S, Đurić Živka, Janković Aleksandar, Tošić Jelena, Popović Jovan, Dimković Nada
Med Pregl. 2014 Nov-Dec;67(11-12):385-91.
The optimal length of dialysis is still under debate and current regimen of 12 hours a week is medically acceptable. The aim of this observational study was to confirm the relationship between different length of dialysis per week and the parameters of dialysis adequacy and cardiovascular morbidity.
The study included 206 patients (128 man and 78 females) who were on maintenance hemodialysis for more than 6 months. They were classified into three groups according to the length of dialysis per week: group I (12 hours), group II (15 hours) and group III (≥17.5 hours).
Index of dyalysis adequacy values did not differ among the groups (group I, II, III = 1.32 vs. 1.51 vs. 1.42; p>0.05); however, the patients from group III had the best bicarbonate level (group I, II and III = 22.7; 21.4; 17.6 mmol/L; p<0.001). In comparison with group I (12 hours), longer dialysis duration was associated with significantly higher hemoglobin values (12.2 vs. 11.4 vs. 10.5 g/dL), less frequent use of erythropoietin stimulating agents (26.9% vs. 65% vs. 86.3%), lower stimulating agents weekly dose (median in group I, II, III = 2000 vs. 5000 vs. 4000 I.J.), lower stimulating agents resistance index (4.9 vs. 7.8 vs. 8.8), significantly higher level of serum albumin (42.3 vs. 40.7 vs. 38.2 g/dL), total cholesterol (5.1 vs. 4.7 vs. 4.5 mmol/L) and serum calcium level (2.38 vs. 2.42 vs. 2.28 mmol/L), less frequent use of phosphate binders (53.8% vs. 85% vs. 84.4%) and calcitriol (19.2% vs. 65% vs. 50.6%) and lower intact parathyroid hormone level (336 vs. 363 vs. 446 pg/ml). In addition, longer dialysis duration was associated with lower cardiovascular morbidity score (0.52 vs. 1.05 vs. 1.26).
Duration of dialysis per week above the current standard positively correlates with parameters of hemodialysis adequacy.
透析的最佳时长仍存在争议，目前每周12小时的治疗方案在医学上是可接受的。这项观察性研究的目的是确认每周不同的透析时长与透析充分性参数及心血管疾病发病率之间的关系。
该研究纳入了206例接受维持性血液透析超过6个月的患者（128例男性和78例女性）。根据每周透析时长，他们被分为三组：第一组（12小时）、第二组（15小时）和第三组（≥17.5小时）。
三组间的透析充分性指标值无差异（第一组、第二组、第三组分别为1.32、1.51、1.42；p>0.05）；然而，第三组患者的碳酸氢盐水平最佳（第一组、第二组和第三组分别为22.7、21.4、17.6 mmol/L；p<0.001）。与第一组（12小时）相比，更长的透析时长与显著更高的血红蛋白值（12.2、11.4、10.5 g/dL）、更少使用促红细胞生成素刺激剂（26.9%、65%、86.3%）、更低的刺激剂每周剂量（第一组、第二组、第三组中位数分别为2000、5000、4000 I.J.）、更低的刺激剂抵抗指数（4.9、7.8、8.8）、显著更高的血清白蛋白水平（42.3、40.7、38.2 g/dL）、总胆固醇（5.1、4.7、4.5 mmol/L）和血清钙水平（2.38、2.42、2.28 mmol/L）、更少使用磷结合剂（53.8%、85%、84.4%）和骨化三醇（19.2%、65%、50.6%）以及更低的全段甲状旁腺激素水平（336、363、446 pg/ml）相关。此外，更长的透析时长与更低的心血管疾病发病率评分相关（0.52、1.05、1.26）。
每周透析时长超过当前标准与血液透析充分性参数呈正相关。
