Alalwan Adel A, Abou Trabeh Aissar, Ahamed Mohamed Mujahith Sb, Jones Samuel, Adjorlolo Donald, Lewis Robert, Sangala Nicholas
Renal Medicine, Portsmouth NHS Hospitals, Portsmouth, GBR.
Cureus. 2023 Feb 16;15(2):e35054. doi: 10.7759/cureus.35054. eCollection 2023 Feb.
Background Although frequent low-flow, low-volume haemodialysis using the NxStage System One is now well-established as an option for home therapy of end-stage chronic kidney disease, its ability to deliver adequate dialysis in people with high BMI remains questionable. This doubt may lead to obese individuals being denied the potential benefits of this modality. To establish if this doubt is justified, we compared dialysis adequacy in two groups of obese individuals; one receiving standard thrice-weekly in-centre haemodialysis and the other receiving frequent haemodialysis at home using the NxStage System One. Methods This is a retrospective observational cohort study of 105 adult dialysis patients with obesity (BMI ≥ 30 kg/m2). All had been on dialysis for at least six months. Fifty-five patients receiving in-centre haemodialysis were compared with 50 patients receiving home haemodialysis using NxStage System One. Dialysis adequacy (standard Kt/V calculated by the Daugirdas equation) was compared between the two groups. The clinical characteristics, laboratory test results, and treatment regimens of each group were also compared. Results The in-centre haemodialysis group was older (63.6 ± 12.8 years vs. 58.5 ± 10.9 years, p=0.033) and had a higher Charlson comorbidity score (5.9 ± 2.1 vs. 4.5 ± 2.5, p=0.003). Standard Kt/V was significantly higher in the home haemodialysis group (2.4 ± 0.5) than in the in-centre haemodialysis group (2.2 ± 0.2) (p = 0.006). The mean serum inorganic phosphate was significantly lower in the home haemodialysis group than in the in-centre haemodialysis group (1.6 ± 0.4 mmol/l vs. 1.8 ± 0.5 mmol/l, p = 0.010). There were no statistically significant differences in the usage of antihypertensives, phosphate binders, or erythropoiesis-stimulating agents between the two groups. Conclusions In this study, dialysis adequacy (expressed as standard Kt/V) was superior to that of standard thrice-weekly in-center haemodialysis delivered by frequent low-volume home haemodialysis using the NxStage System One. Hesitancy about recommending frequent low-volume home haemodialysis to obese individuals is therefore unjustified.
背景 尽管使用NxStage System One进行频繁的低流量、小剂量血液透析现已成为终末期慢性肾病家庭治疗的一种成熟选择，但其在高体重指数人群中提供充分透析的能力仍存在疑问。这种疑虑可能导致肥胖个体无法获得这种治疗方式的潜在益处。为了确定这种疑虑是否合理，我们比较了两组肥胖个体的透析充分性；一组接受标准的每周三次中心血液透析，另一组在家中使用NxStage System One进行频繁血液透析。方法 这是一项对105例肥胖成人透析患者（体重指数≥30kg/m²）的回顾性观察队列研究。所有患者均已接受透析至少六个月。将55例接受中心血液透析的患者与50例使用NxStage System One进行家庭血液透析的患者进行比较。比较两组之间的透析充分性（通过Daugirdas方程计算的标准Kt/V）。还比较了每组的临床特征、实验室检查结果和治疗方案。结果 中心血液透析组年龄较大（63.6±12.8岁 vs. 58.5±10.9岁，p = 0.033），Charlson合并症评分较高（5.9±2.1 vs. 4.5±2.5，p = 0.003）。家庭血液透析组的标准Kt/V（2.4±0.5）显著高于中心血液透析组（2.2±0.2）（p = 0.006）。家庭血液透析组的平均血清无机磷酸盐显著低于中心血液透析组（1.6±0.4mmol/L vs. 1.8±0.5mmol/L，p = 0.010）。两组之间在抗高血压药、磷结合剂或促红细胞生成素的使用方面没有统计学上的显著差异。结论 在本研究中，透析充分性（以标准Kt/V表示）优于使用NxStage System One进行的频繁小剂量家庭血液透析所提供的标准每周三次中心血液透析。因此，对于向肥胖个体推荐频繁小剂量家庭血液透析的犹豫是不合理的。
