See Emily J, Hawley Carmel M, Cho Yeoungjee, Toussaint Nigel D, Agar John Wm, Pascoe Elaine M, Lim Wai H, Francis Ross S, Collins Michael G, Johnson David W
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Nephrology (Carlton). 2019 Jan;24(1):111-120. doi: 10.1111/nep.13221.
Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HD patients, with conflicting results.
This study compared the outcomes of all extended hour (≥24 h/week) and conventional HD patients transplanted in Australia and New Zealand between 2000 and 2014. The primary outcome was delayed graft function (DGF), defined in an ordinal manner as either a spontaneous fall in serum creatinine of less than 10% within 24 h, or the need for dialysis within 72 h following transplantation. Secondary outcomes included the requirement for dialysis within 72 h post-transplant, acute rejection, estimated glomerular filtration rate at 12 months, death-censored graft failure, all-cause and cardiovascular mortality, and a composite of graft failure and mortality.
A total of 4935 HD patients (378 extended hour HD, 4557 conventional HD) received a kidney transplant during the study period. Extended hour HD was associated with an increased likelihood of DGF compared with conventional HD (adjusted proportional odds ratio 1.33; 95% confidence interval 1.06-1.67). There was no significant difference between extended hour and conventional HD in terms of any of the secondary outcomes.
Compared to conventional HD, extended hour HD was associated with DGF, although long-term graft and patient outcomes were not different.
肾移植受者先前接受血液透析（HD）或腹膜透析治疗后的早期移植肾功能差异已有详尽描述。然而，仅有两项单中心研究比较了延长透析时间的HD患者与传统HD患者的移植肾及患者结局，结果相互矛盾。
本研究比较了2000年至2014年间在澳大利亚和新西兰接受移植的所有延长透析时间（≥24小时/周）的HD患者与传统HD患者的结局。主要结局为移植肾功能延迟恢复（DGF），按序贯方式定义为血清肌酐在24小时内自发下降少于10%，或移植后72小时内需要透析。次要结局包括移植后72小时内的透析需求、急性排斥反应、12个月时的估计肾小球滤过率、死亡删失的移植肾失功、全因死亡率和心血管死亡率，以及移植肾失功和死亡率的复合指标。
在研究期间，共有4935例HD患者（378例延长透析时间的HD患者，4557例传统HD患者）接受了肾移植。与传统HD相比，延长透析时间的HD与DGF可能性增加相关（调整后的比例优势比为1.33；95%置信区间为1.06 - 1.67）。在任何次要结局方面，延长透析时间的HD与传统HD之间均无显著差异。
与传统HD相比，延长透析时间的HD与DGF相关，尽管长期移植肾和患者结局并无差异。
