Lin Xinghui, Gu Leyi, Zhu Mingli, Che Miaolin, Yu Zanzhe, Cai Hong, Ni Zhaohui, Zhang Weiming
Kidney Blood Press Res. 2018;43(4):1104-1112. doi: 10.1159/000491566. Epub 2018 Jul 10.
BACKGROUND/AIMS: Twice-weekly hemodialysis(HD) is prevalent in the developing countries, scarce data are available for this treatment in patients with long-term dialysis vintage.
106 patients with more than 5 years HD vintage undergoing twice-weekly HD or thrice-weekly HD in a hemodialysis center in Shanghai between December 1, 2013 and December 31, 2013 were enrolled into the cohort study with 3 years follow-up. Kaplan-Meier analysis and Cox proportional hazards models were used to compare patient survival between the two groups. Subgroup analysis of 62 patients more than 10 years HD vintage was also performed according to their different dialysis frequency.
Compared with patients on thrice-weekly HD, twice-weekly HD patients had significantly longer HD session time and higher single-pool Kt/V (spKt/V) (session time, 4.59±0.45 vs 4.14±0.31 hours/per session, P< 0.001; spKt/V, 2.12±0.31 vs 1.83±0.30, P< 0.001). Kaplan-Meier survival analysis indicated that the two groups had similar survival (P=0.983). Multivariate Cox regression analysis showed that age and time-dependent serum albumin were predictors of patient mortality. Subgroup analysis of 62 patients more than 10 years HD vintage also indicated that the two groups had similar survival. During the follow-up, 4 patients dropped out from the twice-weekly HD group and transferred to thrice-weekly HD.
The similar survival between twice-weekly HD and thrice-weekly HD in patients with long-term dialysis vintage is likely relating to patient selection, individualized treatment for dialysis patients based on clinical features and socioeconomic factors remains a tough task for the clinicians.
背景/目的：每周两次血液透析（HD）在发展中国家很普遍，但关于长期透析患者接受这种治疗的数据却很少。
2013年12月1日至2013年12月31日期间，在上海一家血液透析中心，106例透析龄超过5年且接受每周两次或每周三次HD的患者被纳入队列研究，并进行3年随访。采用Kaplan-Meier分析和Cox比例风险模型比较两组患者的生存率。还根据不同透析频率对62例透析龄超过10年的患者进行了亚组分析。
与每周三次HD的患者相比，每周两次HD的患者透析时长显著更长，单池Kt/V（spKt/V）更高（透析时长：4.59±0.45 vs 4.14±0.31小时/次，P<0.001；spKt/V：2.12±0.31 vs 1.83±0.30，P<0.001）。Kaplan-Meier生存分析表明两组生存率相似（P=0.983）。多因素Cox回归分析显示年龄和随时间变化的血清白蛋白是患者死亡率的预测因素。对62例透析龄超过10年的患者进行的亚组分析也表明两组生存率相似。随访期间，4例患者从每周两次HD组退出并转为每周三次HD。
长期透析患者中，每周两次HD与每周三次HD的生存率相似，这可能与患者选择有关，根据临床特征和社会经济因素对透析患者进行个体化治疗对临床医生来说仍然是一项艰巨的任务。
