Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland.
Division of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.
Nephrol Dial Transplant. 2022 Nov 23;37(12):2514-2521. doi: 10.1093/ndt/gfac205.
Residual kidney function is considered better preserved with incremental haemodialysis (I-HD) or peritoneal dialysis (PD) as compared with conventional thrice-weekly HD (TW-HD) and is associated with improved survival. We aimed to describe outcomes of patients initiating dialysis with I-HD, TW-HD or PD.
We conducted a retrospective analysis of a prospectively assembled cohort in a single university centre including all adults initiating dialysis from January 2013 to December 2020. Primary and secondary endpoints were overall survival and hospitalization days at 1 year, respectively.
We included 313 patients with 234 starting on HD (166 TW-HD and 68 I-HD) and 79 on PD. At the end of the study, 10 were still on I-HD while 45 transitioned to TW-HD after a mean duration of 9.8 ± 9.1 months. Patients who stayed on I-HD were less frequently diabetics (P = .007). Mean follow-up was 33.1 ± 30.8 months during which 124 (39.6%) patients died. Compared with patients on TW-HD, those on I-HD had improved survival (hazard ratio 0.49, 95% confidence interval 0.26-0.93, P = .029), while those on PD had similar survival. Initial kidney replacement therapy modality was not significantly associated with hospitalization days at 1 year.
I-HD is suitable for selected patients starting dialysis and can be maintained for a significant amount of time before transition to TW-HD, with diabetes being a risk factor. Although hospitalization days at 1 year are similar, initiation with I-HD is associated with improved survival as compared with TW-HD or PD. Results of randomized controlled trials are awaited prior to large-scale implementation of I-HD programmes.
与传统每周三次血液透析（TW-HD）相比，增量血液透析（I-HD）或腹膜透析（PD）保留残余肾功能的效果更好，与生存改善相关。我们旨在描述开始接受 I-HD、TW-HD 或 PD 透析的患者的结局。
我们对一个单中心前瞻性队列进行了回顾性分析，纳入了 2013 年 1 月至 2020 年 12 月期间所有开始透析的成年人。主要和次要终点分别为总生存率和 1 年时的住院天数。
共纳入 313 例患者，其中 234 例开始接受 HD 治疗（166 例 TW-HD，68 例 I-HD），79 例开始接受 PD 治疗。研究结束时，10 例仍在接受 I-HD 治疗，45 例在平均 9.8±9.1 个月后转为 TW-HD。继续接受 I-HD 治疗的患者糖尿病发病率较低（P=0.007）。平均随访时间为 33.1±30.8 个月，在此期间 124 例（39.6%）患者死亡。与接受 TW-HD 治疗的患者相比，接受 I-HD 治疗的患者生存率提高（风险比 0.49，95%置信区间 0.26-0.93，P=0.029），而接受 PD 治疗的患者生存率相似。起始肾脏替代治疗方式与 1 年时的住院天数无显著相关性。
I-HD 适合开始透析的部分患者，在过渡到 TW-HD 之前可以维持较长时间，糖尿病是一个危险因素。尽管 1 年时的住院天数相似，但与 TW-HD 或 PD 相比，起始接受 I-HD 治疗与生存率提高相关。在大规模实施 I-HD 项目之前，需要等待随机对照试验的结果。
