Davenport Andrew
UCL Centre for Nephrology, Royal Free Hospital, University College London, Rowland Hill Street, London, NW3 2PF.
Hemodial Int. 2017 Oct;21 Suppl 2:S41-S46. doi: 10.1111/hdi.12592.
Most patients starting hemodialysis (HD) have residual renal function. As such, there has been increased interest in starting patients with less frequent and shorter dialysis session times. However, for this incremental approach to be successful, patients require regular monitoring of residual renal function, so that as residual renal function declines, the amount of HD is appropriately increased. Currently most dialysis centers rely on interdialytic urine collections. However, many patients find these inconvenient and there may be marked intrapatient variability due to compliance issues. Thus, alternative markers of residual renal function are required for routine clinical practice. Currently three middle sized molecules; cystatin C, β2 microglobulin, and βtrace protein have been investigated as potential endogenous markers of glomerular filtration. Although none is ideal, combinations of these markers have been proposed to provide a more accurate estimation of glomerular clearance, and in particular cut offs for minimal residual renal function. However, in patients with low levels of residual renal function it remains unclear as to whether the benefits of residual renal function equally apply to glomerular filtration or tubular function.
大多数开始进行血液透析（HD）的患者都有残余肾功能。因此，人们越来越关注让患者开始接受频率更低、时间更短的透析治疗。然而，要使这种渐进式方法取得成功，患者需要定期监测残余肾功能，以便随着残余肾功能下降，适当增加血液透析的量。目前，大多数透析中心依赖透析间期的尿液收集。然而，许多患者觉得这很不方便，而且由于依从性问题，患者体内可能存在显著的变异性。因此，常规临床实践需要残余肾功能的替代标志物。目前，三种中等大小的分子，即胱抑素C、β2微球蛋白和β-微量蛋白已被作为肾小球滤过的潜在内源性标志物进行研究。尽管没有一种是理想的，但有人提出将这些标志物结合起来，以更准确地估计肾小球清除率，特别是确定最小残余肾功能的临界值。然而，在残余肾功能水平较低的患者中，残余肾功能的益处是否同样适用于肾小球滤过或肾小管功能仍不清楚。
