Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand.
Blood Purif. 2017;44(3):217-226. doi: 10.1159/000475458. Epub 2017 Aug 16.
Many patients with chronic kidney disease start undergoing thrice-weekly haemodialysis (HD), aiming for an HD sessional dialyzer urea clearance target, irrespective of whether they have residual renal function (RRF). While increasing sessional dialyzer urea clearance above a target of 1.2 has not been shown to improve patient survival, it has been shown that the preservation of RRF improves patient self-reported outcomes and survival. Observational studies have suggested that initiating twice-weekly HD schedules leads to greater preservation of RRF. This has led to the concept of following an incremental approach to initiating HD, steadily increasing the amount of weekly dialyzer clearance as RRF decreases. Incremental dialysis practice requires the regular assessment of RRF to prevent inadequate delivery of dialysis treatment. Once RRF is lost, then the dialysis schedule and modality need to be adjusted to try to increase the middle-sized solute clearance and protein-bound toxins.
许多慢性肾脏病患者开始每周接受三次血液透析（HD），以达到 HD 治疗期间透析器尿素清除目标，而不论他们是否有残余肾功能（RRF）。虽然增加治疗期间透析器尿素清除量超过 1.2 的目标并未显示可改善患者的生存，但已表明保留 RRF 可改善患者的自我报告结局和生存。观察性研究表明，开始每周两次 HD 方案可导致 RRF 更好地保留。这导致了采用递增方法开始 HD 的概念，随着 RRF 的减少，逐渐增加每周透析器清除量。递增透析实践需要定期评估 RRF，以防止透析治疗不足。一旦 RRF 丧失，那么需要调整透析方案和方式，以尝试增加中分子量溶质清除率和蛋白结合毒素。
