Panagoutsos Stelios A, Yannatos Evangelos V, Passadakis Ploumis S, Thodis Elias D, Galtsidopoulos Omiros G, Vargemezis Vassilis A
Democritus University of Thrace, Division of Nephrology, G.D. Hospital of Alexandroupolis, Alexandroupolis, Greece.
Hemodial Int. 2001 Jan;5(1):51-54. doi: 10.1111/hdi.2001.5.1.51.
Good evidence suggests that improvements in dialysis efficiency reduce morbidity and mortality of hemodialysis (HD) patients. Dialysis efficiency has also been related to better control of arterial blood pressure (BP), anemia, and serum phosphorus levels, and to improvement in patients' nutritional status. Over a 2-year period, the present self-controlled study of 34 HD patients (23 men, 11 women; age, 52.6 ± 14.5 years; HD duration, 55.9 ± 61.2 months) looked at the effect on clinical and laboratory parameters of increasing the delivered dialysis dose under a strict dry-weight policy. Dialysis dose was increased without increasing dialysis time and frequency. A statistically significant increase was seen in delivered HD dose: the urea reduction ratio (URR) increased to 60% ± 10% from 52% ± 8%, and then to 71% ± 7% (p < 0.001); Kt/V increased to 1.22 ± 0.28 from 0.93 ± 0.19, and then to 1.55 ± 0.29 (p < 0.001). A statistically significant increase in hemoglobin concentration also occurred-to 10.8 ± 1.9 g/dL from 10.4 ± 1.7 g/dL, and then to 11.0 ± 1.3 g/dL (p < 0.05 as compared to baseline)-with no significant difference in weekly erythropoietin dose. Statistically significant decreases occurred in the systolic and diastolic blood pressures during the first year; they then remained unchanged. Systolic blood pressure decreased to 131 ± 23 mmHg from 147 ± 24 mmHg (p < 0.001); diastolic blood pressure decreased to 65 ± 11 mmHg from 73 ± 12 mmHg (p < 0.001). Serum albumin increased insignificantly to 4.4 ± 0.4 g/dL from 4.3 ± 0.4 g/dL, and then significantly to 4.6 ± 0.3 g/dL (p = 0.002 as compared to both previous values). Normalized protein catabolic rate increased significantly to 1.16 ± 0.15 g/kg/day from 0.93 ± 0.16 g/kg/ day (p < 0.001), and then to 1.20 ± 0.17 g/kg/day (p < 0.001 as compared to baseline). We conclude that the increases achieved in average Kt/V per hemodialysis session by increasing dialyzer membrane area, and blood and dialysate flows, without increasing dialysis time above 4 hours, in patients hemodialyzed thrice weekly, coupled with strict dry-weight policy, resulted in improvements in hypertension, nutritional status, and anemia.
有力证据表明，提高透析效率可降低血液透析（HD）患者的发病率和死亡率。透析效率还与更好地控制动脉血压（BP）、贫血和血清磷水平以及改善患者营养状况有关。在为期2年的时间里，本项针对34例HD患者（23例男性，11例女性；年龄52.6±14.5岁；HD病程55.9±61.2个月）的自身对照研究，观察了在严格干体重策略下增加透析剂量对临床和实验室参数的影响。在不增加透析时间和频率的情况下增加了透析剂量。透析剂量显著增加：尿素清除率（URR）从52%±8%增至60%±10%，随后又增至71%±7%（p<0.001）；Kt/V从0.93±0.19增至1.22±0.28，随后又增至1.55±0.29（p<0.001）。血红蛋白浓度也出现显著增加——从10.4±1.7g/dL增至10.8±1.9g/dL，随后又增至11.0±1.3g/dL（与基线相比p<0.05），而促红细胞生成素的每周剂量无显著差异。第一年收缩压和舒张压出现显著下降，之后保持不变。收缩压从147±24mmHg降至131±23mmHg（p<0.001）；舒张压从73±12mmHg降至65±11mmHg（p<0.001）。血清白蛋白从4.3±0.4g/dL无显著增加至4.4±0.4g/dL，随后显著增至4.6±0.3g/dL（与前两个值相比p=0.002）。标准化蛋白分解代谢率从0.93±0.16g/kg/天显著增至1.16±0.15g/kg/天（p<0.001），随后又增至1.20±0.17g/kg/天（与基线相比p<0.001）。我们得出结论，对于每周进行三次血液透析的患者，在不将透析时间增加至4小时以上的情况下，通过增加透析器膜面积、血液和透析液流量，使每次血液透析疗程的平均Kt/V增加，并结合严格的干体重策略，可改善高血压、营养状况和贫血。
