Dai Li, Lu Chan, Liu Jinnv, Li Shanshan, Jin Huanlin, Chen Fadong, Xue Zengqi, Miao Chusheng
Department of Nephrology, Ruian People's Hospital, Ruian City, Wenzhou, Zhejiang, China.
Medicine (Baltimore). 2020 May;99(20):e20202. doi: 10.1097/MD.0000000000020202.
Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies.
This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed.
One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ± 4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group.
Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.
维持性血液透析（MHD）频率与生存率及并发症发生率相关。在医疗保健、生活质量（QOL）和医疗成本之间实现最佳平衡具有挑战性。我们比较了不同MHD频率患者的并发症、炎症状态、营养状况和生活质量。
这是一项对2011年5月至2017年8月在温州3家三级医院接受治疗的患者进行的多中心随机试验。患者根据其1年的治疗方案分组：每周两次或每周三次。评估并发症、生化参数和生活质量（KDQOL-SFTM 1.3量表）。
纳入140例年龄在29至68岁之间的患者（平均年龄50.9±4.3岁）。两组在感染、心力衰竭或脑出血并发症方面无显著差异（P = 0.664）。两组透析前血红蛋白、高敏C反应蛋白、血清白蛋白、总胆固醇、甘油三酯、钙、磷、甲状旁腺激素和射血分数相似（P > 0.05）。MHD治疗1年后，两组这些参数均有显著改善（所有P < 0.05），组间无显著差异。治疗后血清肌酐、血尿素氮（BUN）和每周标准血液透析治疗充分性未改善（所有P > 0.05），尽管两组间BUN存在差异（P < 0.001）。除社会支持方面每周三次组略优于每周两次组外，每周两次组的生活质量优于每周三次组（所有P < 0.05）。
每周两次和每周三次的MHD在炎症和营养临床结局及不良事件方面相当。每周两次方案的生活质量更好。即使对于经济受限的患者，在考虑基线BUN水平后，选择每周两次或三次的MHD也应谨慎。
