Imaizumi Takahiro, Okazaki Masaki, Hishida Manabu, Kurasawa Shimon, Nishibori Nobuhiro, Nakamura Yoshihiro, Ishikawa Shigefumi, Suzuki Katsuhiko, Takeda Yuki, Otobe Yuhei, Kondo Toru, Kaneda Fumika, Kaneda Hiroshi, Maruyama Shoichi
Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 464-8550, Japan.
Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan.
Clin Exp Nephrol. 2025 Jan 28. doi: 10.1007/s10157-024-02602-7.
Protein-energy wasting (PEW), a unique weight loss linked to nutritional and metabolic abnormalities, is common in patients undergoing hemodialysis (HD) and associated with adverse outcomes. This study investigated whether extended-hours HD combined with a liberalized diet could overcome PEW and improve survival.
The body mass index (BMI) and survival outcomes in patients undergoing extended-hours HD were evaluated for up to 8 years using data from the LIBeralized diet Extended-houRs hemodialysis Therapy (LIBERTY) cohort. Extended-hours HD was defined as weekly dialysis length ≥ 18 h.
The LIBERTY cohort included 402 patients who initiated extended-hours HD. An increase in the length and frequency of HD sessions was observed over time, with approximately 70% and 20% of patients undergoing extended-hours HD for > 21 h/week and > 3 sessions/week at 5 years, respectively. The BMI and percentage creatinine generation rate were maintained over time, with no substantial increase in the phosphorus and potassium levels. The estimated BMI initially increased, and thereafter plateaued over time in patients with a baseline BMI < 25 kg/m, whereas it decreased gradually in patients with a baseline BMI ≥ 25 kg/m after several years from baseline. Ninety-one patients died, and 108 discontinued extended-hours HD during the median follow-up period of 6.2 years (interquartile range, 3.5-8.0), yielding a 5-year survival rate of 85%.
Extended-hours HD with a liberalized diet may help achieve favorable survival outcomes and maintain nutritional status. Thus, it is a promising treatment option for managing PEW in patients undergoing HD.
蛋白质能量消耗（PEW）是一种与营养和代谢异常相关的独特体重减轻现象，在接受血液透析（HD）的患者中很常见，并与不良预后相关。本研究调查了延长透析时间的HD联合宽松饮食是否能克服PEW并改善生存率。
使用来自宽松饮食延长透析时间血液透析治疗（LIBERTY）队列的数据，对接受延长透析时间HD的患者的体重指数（BMI）和生存结局进行了长达8年的评估。延长透析时间的HD定义为每周透析时长≥18小时。
LIBERTY队列包括402例开始延长透析时间HD的患者。随着时间的推移，观察到HD疗程的时长和频率增加，5年时分别约有70%和20%的患者接受每周>21小时和>3次的延长透析时间HD。BMI和肌酐生成率百分比随时间保持稳定，磷和钾水平没有大幅增加。基线BMI<25kg/m²的患者，估计BMI最初增加，此后随时间趋于平稳；而基线BMI≥25kg/m²的患者，从基线起数年后BMI逐渐下降。在6.2年的中位随访期（四分位间距，3.5 - 8.0）内，91例患者死亡，108例停止延长透析时间HD，5年生存率为85%。
延长透析时间的HD联合宽松饮食可能有助于实现良好的生存结局并维持营养状况。因此，它是管理接受HD患者PEW的一种有前景的治疗选择。
