Sirich Tammy L, Tan Zijian, Highland Benjamin R, Lin Zhidong, Russell Gregory B, Murea Mariana
Department of Medicine, Stanford University, Palo Alto, California, USA.
Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.
Kidney Int Rep. 2024 Mar 13;9(6):1774-1782. doi: 10.1016/j.ekir.2024.03.015. eCollection 2024 Jun.
Longitudinal changes in residual kidney function have not been well-examined in patients starting chronic hemodialysis (HD).
We analyzed urine volume and kidney solute clearances from timed urine collections and corresponding plasma samples from 42 patients randomized to incremental HD ( = 21) and conventional HD ( = 21) in the TwoPlus pilot study. Samples were collected before HD initiation (baseline); and at 6, 12, 24, and 48 weeks. We assessed temporal trends in urine volume, kidney urea and creatinine clearance, and correlations between urine volume and kidney solute clearance.
Residual kidney function parameters in all patients declined over time; the pattern of decline differed between urine volume and kidney solute clearances. Urine volume declined at a steady rate with median (quartile 1, quartile 3) percentage change relative to baseline of -10% (-36 to 29) at week 6 and -47% (-76 to 5) by week 48. Kidney urea and creatinine clearances exhibited a larger decline than urine volume at week 6, -32% (-61 to 8) and -47% (-57 to -20), respectively. The rate of decline subsequently slowed, reaching about 61% decline for both solutes by week 48. Conventional HD demonstrated larger declines in urine volume and kidney urea clearance than incremental HD at week 6. Urine volume showed moderate correlation with urea (R = 0.47) and weaker correlation with creatinine (R = 0.34).
Despite gradual decrement in urine volume and kidney solute clearances, residual kidney function persists nearly 1 year after HD initiation. This knowledge could motivate increased practice of individualizing HD prescriptions by incorporating residual kidney function.
对于开始进行慢性血液透析（HD）的患者，残余肾功能的纵向变化尚未得到充分研究。
在TwoPlus试点研究中，我们分析了42例随机分为递增式HD（n = 21）和传统HD（n = 21）患者的定时尿液收集量及肾脏溶质清除率，以及相应的血浆样本。样本在HD开始前（基线）、6周、12周、24周和48周时采集。我们评估了尿量、肾脏尿素和肌酐清除率的时间趋势，以及尿量与肾脏溶质清除率之间的相关性。
所有患者的残余肾功能参数均随时间下降；尿量和肾脏溶质清除率的下降模式有所不同。尿量以稳定速率下降，相对于基线的中位数（四分位数1，四分位数3）百分比变化在第6周时为-10%（-36至29），到第48周时为-47%（-76至5）。肾脏尿素和肌酐清除率在第6周时下降幅度大于尿量，分别为-32%（-61至8）和-47%（-57至-20）。随后下降速率减慢，到第48周时两种溶质的下降幅度均达到约61%。在第6周时，传统HD的尿量和肾脏尿素清除率下降幅度大于递增式HD。尿量与尿素呈中度相关（R = 0.47），与肌酐的相关性较弱（R = 0.34）。
尽管尿量和肾脏溶质清除率逐渐下降，但残余肾功能在HD开始后仍持续近1年。这一认识可能会促使通过纳入残余肾功能来增加HD处方个体化的实践。
