Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem.
University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine.
Curr Opin Nephrol Hypertens. 2022 Jan 1;31(1):92-99. doi: 10.1097/MNH.0000000000000754.
Advanced kidney failure requiring dialysis, commonly labeled end-stage kidney disease or chronic kidney disease stage 5D, is a heterogeneous syndrome -a key reason that may explain why: treating advanced kidney dysfunction is challenging and many clinical trials involving patients on dialysis have failed, thus far. Treatment with dialytic techniques - of which maintenance thrice-weekly hemodialysis is most commonly used - is broadly named kidney 'replacement' therapy, a term that casts the perception of a priori abandonment of intrinsic kidney function and subsumes patients into a single, homogeneous group.
Patients with advanced kidney failure necessitating dialytic therapy may have ongoing endogenous kidney function, and differ in their clinical manifestations and needs. Different terminology, for example, kidney dysfunction requiring dialysis (KDRD) with stages of progressive severity could better capture the range of phenotypes of patients who require kidney 'assistance' therapy.
Classifying patients with KDRD based on objective, quantitative levels of endogenous kidney function, as well as patient-reported symptoms and quality of life, would facilitate hemodialysis prescriptions tailored to level of kidney dysfunction, clinical needs, and personal priorities. Such classification would encourage clinicians to move toward personalized, physiological, and adaptive approach to hemodialysis therapy.
需要透析的晚期肾衰竭，通常被标记为终末期肾病或慢性肾脏病 5 期，是一种异质性综合征——这可能是迄今为止治疗晚期肾功能障碍具有挑战性且许多涉及透析患者的临床试验都失败的一个关键原因。使用透析技术进行治疗——其中最常用的是每周三次维持性血液透析——通常被称为肾脏“替代”治疗，该术语暗示了对固有肾功能的先验放弃，并将患者归入一个单一的、同质的群体。
需要透析治疗的晚期肾衰竭患者可能仍有内源性肾功能，且临床表现和需求存在差异。例如，使用不同的术语，如需要透析的肾功能障碍（KDRD）及其进展严重程度的分期，可能更能捕捉需要肾脏“辅助”治疗的患者的表型范围。
根据内源性肾功能的客观、定量水平以及患者报告的症状和生活质量对 KDRD 患者进行分类，将有助于根据肾功能障碍程度、临床需求和个人优先事项来定制血液透析处方。这种分类将鼓励临床医生采用个性化、生理性和适应性的血液透析治疗方法。
