Department of Nephrology, The Royal Melbourne Hospital, Parkville, VIC, 3052, Australia.
Department of Nephrology, Barwon Health, Geelong, VIC, Australia.
Int Urol Nephrol. 2020 Apr;52(4):757-764. doi: 10.1007/s11255-020-02419-9. Epub 2020 Mar 2.
Residual kidney function (RKF) provides substantial volume and solute clearance even after dialysis initiation. Preservation of RKF is associated with improved outcomes including mortality in patients on both peritoneal and haemodialysis (HD). Factors predicting RKF loss are unclear, including HD modality. Nocturnal haemodialysis (NHD) may result in less aggressive fluid and solute shifts, however, retrospective data suggests frequent NHD may accelerate RKF decline. The aim of the study was to determine if decline in RKF differs between patients undergoing conventional haemodialysis (CHD) versus NHD.
A prospective observational study of incident HD patients was undertaken comparing patients undertaking CHD (4-5 h, 3 days/week) and NHD (8 h, 3-5 nights/week). Change in RKF was measured by urea and creatinine clearance (48-h interdialytic urine collection) and glomerular filtration rate (GFR) (Cr51-EDTA nuclear scan) at initiation of dialysis (baseline) and 12 months.
A total of 18 incident HD patients were recruited (8 CHD, 10 NHD). Three patients withdrew after baseline (n = 15). Baseline RKF was similar between groups with mean nuclear GFR of 13.3 ± 4.1 mL/min in the CHD cohort vs 13.5 ± 4.6 mL/min in the NHD group (p = 0.89). Baseline urine volume was 2399 ± 950 mLs and 2794 ± 1662 mLs in the CHD and NHD, respectively (p = 0.57). Nuclear GFR declined from time 0 to 12 months to 9.3 ± 2.5 mL/min and 10.4 ± 4.3 mL/min in the CHD and NHD, respectively (p = 0.52). There was a significant decline in 48-h urine volume over 12 months with a mean volume of 1943 ± 1087.0 mLs in the CHD compared to 601.7 ± 315.3 mLs in the NHD (p = 0.01). No significant difference was found in other measures of RKF between groups over 12 months.
This small prospective cohort study found that the loss of residual urine volume was greater in the NHD vs the CHD cohort but there was no difference in other measures of RKF.
即使在开始透析后，残余肾功能 (RKF) 仍能提供大量的容量和溶质清除。保留 RKF 与改善结果相关，包括腹膜和血液透析 (HD) 患者的死亡率。预测 RKF 丧失的因素尚不清楚，包括 HD 方式。夜间血液透析 (NHD) 可能导致更不剧烈的液体和溶质转移，然而，回顾性数据表明频繁的 NHD 可能会加速 RKF 下降。本研究的目的是确定接受常规血液透析 (CHD) 与 NHD 的患者之间 RKF 的下降是否存在差异。
对接受 HD 的新发病例患者进行前瞻性观察研究，比较接受 CHD（4-5 小时，每周 3 天）和 NHD（8 小时，每周 3-5 晚）的患者。通过尿素和肌酐清除率（48 小时透析间尿液收集）和肾小球滤过率（Cr51-EDTA 核扫描）在透析开始时（基线）和 12 个月时测量 RKF 的变化。
共招募了 18 名新发病例 HD 患者（8 名 CHD，10 名 NHD）。3 名患者在基线后退出（n=15）。两组的基线 RKF 相似，CHD 组的核 GFR 平均值为 13.3±4.1mL/min，NHD 组为 13.5±4.6mL/min（p=0.89）。基线时尿量分别为 2399±950mL 和 2794±1662mL（p=0.57）。核 GFR 从 0 时间到 12 个月下降到 CHD 和 NHD 组分别为 9.3±2.5mL/min 和 10.4±4.3mL/min（p=0.52）。12 个月时，48 小时尿液量有明显下降，CHD 组平均尿量为 1943±1087.0mL，而 NHD 组为 601.7±315.3mL（p=0.01）。12 个月时，两组之间 RKF 的其他指标无显著差异。
这项小型前瞻性队列研究发现，与 CHD 组相比，NHD 组残余尿体积的丢失更大，但 RKF 的其他指标无差异。
