Noori Nazanin, Yan Andrew T, Kiaii Mercedeh, Rathe Andrea, Goldstein Marc B, Bello Olugbenga, Wald Ron
Division of Nephrology, St. Michael's Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada.
Division of Cardiology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Int Urol Nephrol. 2017 Aug;49(8):1453-1461. doi: 10.1007/s11255-017-1595-x. Epub 2017 Apr 29.
Recipients of conventional hemodialysis (CHD; 3-4 h/session, 3 times/week) experience volume expansion and nutritional impairment which may contribute to high mortality. Prolongation of sessions with in-centre nocturnal hemodialysis (INHD; 7-8 h/session, 3 times/week) may improve clinical outcomes by enhancement of ultrafiltration and uremic toxin removal.
In this prospective cohort study, 56 adult patients who were receiving maintenance CHD for at least 90 days were assigned to CHD (patients who remained in CHD) and INHD (patients who switched to INHD) groups. Both groups were followed for 1 year divided into four 13-week quarters; post-dialysis weight and interdialytic weight gain (IDWG) were captured in each quarter. Repeated measures analysis of variance was used to calculate group main effect, time main effect or time-group interaction effect.
Conversion to INHD was associated with a mean (95% confidence interval) change in IDWG of 0.5 (0.08, 1.2) kg as compared to -0.3 (-0.9, 0.1) kg in the CHD group (p < 0.01). In the INHD group, post-dialysis weight (% of baseline pre-dialysis weight) decreased after conversion, reaching a nadir during the first 3 months (0.7%) and subsequently it gradually increased and returned to its baseline at the end of follow-up. A similar temporal trend was seen for serum creatinine but not serum N-terminal pro-brain natriuretic peptide (NT-proBNP) which is a marker of extracellular volume. The changes in serum albumin, prealbumin and hs-CRP were not different between the two groups.
Conversion to INHD was associated with greater IDWG and relatively stable body mass. We speculate that this gain in weight reflects an increase in lean body mass following the change in dialysis modality, which can be concluded from the parallel increase in serum creatinine and the lack of increase in NT-proBNP.
接受常规血液透析（CHD；每次治疗3 - 4小时，每周3次）的患者会出现容量扩张和营养损害，这可能是导致高死亡率的原因。通过延长中心夜间血液透析（INHD；每次治疗7 - 8小时，每周3次）的治疗时间，可能会通过增强超滤和清除尿毒症毒素来改善临床结局。
在这项前瞻性队列研究中，56名接受维持性CHD至少90天的成年患者被分为CHD组（继续接受CHD治疗的患者）和INHD组（转为接受INHD治疗的患者）。两组均随访1年，分为四个13周的季度；每季度记录透析后体重和透析间期体重增加量（IDWG）。采用重复测量方差分析来计算组间主效应、时间主效应或时间 - 组间交互效应。
转为INHD治疗后，IDWG的平均（95%置信区间）变化为0.5（0.08，1.2）kg，而CHD组为 - 0.3（ - 0.9，0.1）kg（p < 0.01）。在INHD组中，转为INHD治疗后透析后体重（占透析前基线体重的百分比）下降，在最初3个月降至最低点（0.7%），随后逐渐增加，并在随访结束时恢复到基线水平。血清肌酐呈现类似的时间趋势，但作为细胞外液标志物的血清N末端脑钠肽前体（NT - proBNP）则不然。两组血清白蛋白、前白蛋白和高敏C反应蛋白的变化无差异。
转为INHD治疗与更大的IDWG和相对稳定的体重相关。我们推测这种体重增加反映了透析方式改变后瘦体重的增加，这可以从血清肌酐的平行增加以及NT - proBNP未增加得出结论。
