Libetta Carmelo, Nissani Peni, Dal Canton Antonio
Unit of Nephrology, Dialysis, Transplantation, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
University of Pavia, Pavia, Italy.
Semin Dial. 2016 May;29(3):179-83. doi: 10.1111/sdi.12455. Epub 2015 Nov 15.
Progressive hemodialysis is based on the simple idea of adjusting its dose according to residual renal function (RRF). The progressive, infrequent paradigm is slowly gaining a foothold among nephrologists, despite a lot of skepticism in the scientific world. Given the importance of RRF preservation in conservative therapy, it seems a contradiction to ignore the contribution of RRF when patients initiate hemodialysis (HD), especially when it is routinely considered with peritoneal dialysis. While a three-times-weekly HD regimen is broadly considered the standard starting regimen for new patients, twice-weekly HD has been used in selected patients and is currently a common practice in South-East Asia. Small studies indicate that a once-weekly HD regimen may be a viable starting option as well. Progressive hemodialysis still requires validation, yet it is promising. We share the belief that a randomized clinical trial to investigate progressive hemodialysis is much needed, but we also strongly recommend including a once-weekly HD starting dose as part of any such investigation.
渐进性血液透析基于根据残余肾功能（RRF）调整透析剂量这一简单理念。尽管科学界对此存在诸多质疑，但这种逐渐增加、不频繁的模式在肾病学家中正逐渐站稳脚跟。鉴于在保守治疗中保留RRF的重要性，在患者开始血液透析（HD）时忽视RRF的作用似乎自相矛盾，尤其是在常规将其与腹膜透析相比较时。虽然每周三次的HD方案被广泛认为是新患者的标准起始方案，但每周两次的HD已用于特定患者，并且目前在东南亚是一种常见做法。小型研究表明，每周一次的HD方案也可能是一个可行的起始选择。渐进性血液透析仍需验证，但很有前景。我们认同这样的观点，即迫切需要进行一项随机临床试验来研究渐进性血液透析，但我们也强烈建议将每周一次的HD起始剂量纳入任何此类研究。
