Duggal Vishal, Hussein Wael F, Reiterman Marc, Sun Sumi J, Abra Graham E, Schiller Brigitte
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.
Medical Clinical Affairs, Satellite Healthcare, California, San Jose, USA.
Hemodial Int. 2019 Apr;23(2):223-229. doi: 10.1111/hdi.12741. Epub 2019 Mar 4.
A majority of patients with end-stage renal disease (ESRD) on in-center hemodialysis (HD) require several hours to recover from an HD session. Patients and caregivers identify fatigue as a high priority for improvement. However, evidence for practical interventions to improve recovery time from conventional in-center HD is lacking. The effect of blood flow rate reduction on dialysis recovery time (DRT) is unknown.
Multicenter, single-blinded, randomized, parallel-design controlled trial of blood flow rate reduction vs. usual care. One-hundred two patients with ESRD undergoing maintenance HD in 18 centers with baseline DRT of greater than 6 hours were included as subjects. The intervention was a blood flow rate reduction of 100 mL/min, to a minimum of 300 mL/min. The primary outcome was the between-group difference in change in DRT. Secondary outcomes were changes in London Evaluation of Illness (LEVIL) survey responses from baseline.
Baseline median DRT was 720 (IQR 360-1013) minutes in controls and 720 (IQR 360-1106) minutes in the intervention group. DRT decreased in both groups. Mean change from baseline (95% confidence interval) at Week 4 in the study was -324 (-473, -175) minutes in the control group and -120 (-329, 90) minutes in the intervention group. The change from baseline was more profound in the control group (P = 0.05). Secondary outcomes of measures of quality of life reported on the LEVIL survey showed more improvement in patients' feelings of general well-being in the control group (P = 0.01). Differences between groups in pain, feeling washed out or drained, sleep quality, shortness of breath, and appetite were not statistically significant.
Blood flow rate reduction did not improve DRT over usual care. Though more work needs to be done to address patient-reported fatigue, a significant positive impact may not be achieved without substantial changes in dialysis prescription.
大多数接受中心血液透析（HD）的终末期肾病（ESRD）患者需要数小时才能从HD治疗中恢复。患者和护理人员将疲劳视为亟待改善的问题。然而，缺乏关于改善传统中心HD恢复时间的实际干预措施的证据。血流速率降低对透析恢复时间（DRT）的影响尚不清楚。
进行一项多中心、单盲、随机、平行设计的对照试验，比较血流速率降低与常规护理。18个中心的102例接受维持性HD且基线DRT大于6小时的ESRD患者被纳入研究对象。干预措施为将血流速率降低100 mL/min，最低降至300 mL/min。主要结局是两组DRT变化的组间差异。次要结局是伦敦疾病评估（LEVIL）调查从基线开始的反应变化。
对照组基线DRT中位数为720（四分位间距360 - 1013）分钟，干预组为720（四分位间距360 - 1106）分钟。两组DRT均下降。研究第4周时，对照组从基线的平均变化（95%置信区间）为-324（-473，-175）分钟，干预组为-120（-329，90）分钟。对照组从基线的变化更为显著（P = 0.05）。LEVIL调查中报告的生活质量测量的次要结局显示，对照组患者的总体幸福感改善更大（P = 0.01）。两组在疼痛、感到疲惫或精力耗尽、睡眠质量、呼吸急促和食欲方面的差异无统计学意义。
与常规护理相比，血流速率降低并未改善DRT。尽管需要做更多工作来解决患者报告的疲劳问题，但如果透析处方没有实质性改变，可能无法取得显著的积极效果。
