Merino José L, Domínguez Patricia, Bueno Blanca, Amézquita Yésika, Espejo Beatriz, Paraíso Vicente
Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
Nefrologia. 2017 Jan-Feb;37(1):39-46. doi: 10.1016/j.nefro.2016.11.015.
The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008.
We included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: Clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities.
A total of 24patients were included in incremental technique. The mean age at start of RRT was 60 (15 years. The average time on incremental technique was 19 (18 months (range: 7-80), with a mean time on dialysis of 31 (23 months (range: 12-86). The reasons for transfer to thrice-weekly HD were: in 6patients due to laboratory tests, in 2patients for heart failure events, one for poor compliance and 3for receiving a kidney graft. The residual diuresis decreased in the first year from 2,106 (606ml/day to 1,545 (558 (P=.17) with the urea clearance and calculated residual renal function, basal 5.7 (1.5vs. 3.8 (1.9ml/min per year (P=.01) and basal 8.9 (2.4vs. 6.9 (4.3 per year (P=.28), respectively.
Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.
在开始肾脏替代治疗（RRT）时，保留残余肾功能的需求在腹膜透析等技术中很常见，但在血液透析（HD）中则较少见。在我们中心，递增式透析模式（每周2次HD）已成为一组患者的选择。在此，我们分享自2008年3月以来采用该方案的经验。
我们纳入了残余尿量>1000ml/24小时、临床稳定、无水肿、血钾>6.5mEq/l和血磷>6mg/dl情况不存在且对饮食护理有可接受理解能力的初治患者。排除标准为：临床不稳定、无饮食或医疗依从性以及上述实验室异常情况。
共有24例患者采用递增技术。开始RRT时的平均年龄为60岁（15岁）。递增技术的平均使用时间为19个月（18个月，范围：7 - 80个月），透析平均时间为31个月（23个月，范围：12 - 86个月）。转为每周三次HD的原因如下：6例因实验室检查，2例因心力衰竭事件，1例因依从性差，3例因接受肾移植。第一年残余尿量从2106±606ml/天降至1545±55（P = 0.17），尿素清除率和计算得出的残余肾功能分别为：基础值5.7±1.5对比每年3.8±1.9ml/分钟（P = 0.01），基础值8.9±2.4对比每年6.9±4.3（P = 0.28）。
每周两次HD的递增式HD治疗可能是部分患者的一种选择。这种方法至少在第一年能很大程度上保留残余肾功能。尽管这种模式可能不适用于所有开始RRT的患者，但它可以且应该是首先考虑的一种选择。
