The Departments of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, California, USA.
The Departments of Medicine, VA Palo Alto HCS and Stanford University, Palo Alto, California, USA.
Kidney Int. 2017 May;91(5):1186-1192. doi: 10.1016/j.kint.2016.11.002. Epub 2017 Jan 12.
The Frequent Hemodialysis Network Daily Trial compared conventional three-times weekly treatment to more frequent treatment with a longer weekly treatment time in patients receiving in-center hemodialysis. Evaluation at one year showed favorable effects of more intensive treatment on left ventricular mass, blood pressure, and phosphate control, but modest or no effects on physical or cognitive performance. The current study compared plasma concentrations of uremic solutes in stored samples from 53 trial patients who received three-times weekly in-center hemodialysis for an average weekly time of 10.9 hours and 30 trial patients who received six-times weekly in-center hemodialysis for an average of 14.6 hours. Metabolomic analysis revealed that increased treatment frequency and time resulted in an average reduction of only 15 percent in the levels of 107 uremic solutes. Quantitative assays confirmed that increased treatment did not significantly reduce levels of the putative uremic toxins p-cresol sulfate or indoxyl sulfate. Kinetic modeling suggested that our ability to lower solute concentrations by increasing hemodialysis frequency and duration may be limited by the presence of non-dialytic solute clearances and/or changes in solute production. Thus, failure to achieve larger reductions in uremic solute concentrations may account, in part, for the limited benefits observed with increasing frequency and weekly treatment time in Frequent Hemodialysis Daily Trial participants.
频繁血液透析网络每日试验比较了常规每周三次治疗与更频繁的治疗，每周治疗时间更长，在接受中心血液透析的患者中。一年的评估显示，更强化的治疗对左心室质量、血压和磷酸盐控制有有利影响，但对身体或认知功能的影响适度或没有。本研究比较了存储的样本中尿毒症溶质的血浆浓度，这些样本来自 53 名接受每周三次中心血液透析治疗的试验患者，平均每周治疗时间为 10.9 小时，和 30 名接受每周六次中心血液透析治疗的试验患者，平均每周治疗时间为 14.6 小时。代谢组学分析显示，增加治疗频率和时间仅使 107 种尿毒症溶质的水平平均降低了 15%。定量分析证实，增加治疗并没有显著降低潜在尿毒症毒素对甲酚硫酸酯或吲哚硫酸酯的水平。动力学模型表明，我们通过增加血液透析频率和时间来降低溶质浓度的能力可能受到非透析溶质清除率和/或溶质产生变化的限制。因此，未能实现尿毒症溶质浓度更大程度的降低，可能部分解释了在频繁血液透析网络每日试验参与者中，增加频率和每周治疗时间的益处有限。
