Kittiskulnam Piyawan, Tiranathanagul Khajohn, Susantitaphong Paweena, Phannajit Jeerath, Chongpison Yuda, Asavapujanamanee Pagaporn, Surattichaiyakul Bongkod, Takkavatakarn Kullaya, Katavetin Pisut, Metta Kamonchanok, Praditpornsilpa Kearkiat
Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Nutrients. 2025 Jul 24;17(15):2422. doi: 10.3390/nu17152422.
Rapid loss of residual kidney function (RKF) is associated with unfavorable outcomes. We conducted an RCT to compare the effects on RKF preservation of incremental HD between once-weekly HD (1-WHD) and twice-weekly HD (2-WHD). ESKD patients with an eGFR of 5-10 mL/min/1.73 m and urine output of ≥800 mL/day were randomly assigned to receive either once-weekly HD (1-WHD) or twice-weekly HD (2-WHD) for 12 months. Patients in the 1-WHD group were prescribed once-weekly HD combined with low-protein diet (0.6 g/kg/day) supplemented with keto-analogues (KAs) 0.12 g/kg/day. In the 2-WHD group, patients received twice-weekly HD with a regular-protein diet. Primary outcomes were changes in RKF by renal clearance and urine volume. Nutritional status, muscle parameters, and quality of life (QoL) were also assessed. A total of 30 incident HD patients were randomized. Baseline RKF, urine volume, and demographic were not different between groups. After 3 months, urine volume was significantly higher in the 1-WHD group than in the 2-WHD group (1921 ± 767 mL/day vs. 1305 ± 599 mL/day, = 0.02), and these significant findings persisted throughout the entire study period. For RKF, 1-WHD also had a lesser decline in urinary urea (CUrea) and creatinine clearance (CCr) than 2-WHD, with statistically significant differences observed from months 6-12. By month 6, the 1-WHD group exhibited significantly higher CUrea and CCr compared to the 2-WHD group, with CUrea at 3.2 ± 2.3 vs. 1.7 ± 1.0 mL/min ( = 0.03) and CCr at 5.9 ± 3.6 vs. 3.8 ± 1.4 mL/min ( = 0.04), respectively. Serum albumin levels, skeletal muscle mass, anemia status, metabolic parameters, protein-bound uremic toxins, and QoL scores were comparable between the two groups. Incremental HD, starting with once-weekly HD combined with protein restriction supplemented with KAs, appears to better preserve RKF among incident HD patients compared to twice-weekly HD with a regular-protein diet. This HD regimen was also associated with safety in metabolic and nutritional profiles.
残余肾功能（RKF）的快速丧失与不良预后相关。我们进行了一项随机对照试验（RCT），以比较每周一次血液透析（1-WHD）和每周两次血液透析（2-WHD）的增量血液透析对RKF保留的影响。估算肾小球滤过率（eGFR）为5-10 mL/min/1.73 m²且尿量≥800 mL/天的终末期肾病（ESKD）患者被随机分配接受每周一次血液透析（1-WHD）或每周两次血液透析（2-WHD），为期12个月。1-WHD组的患者被规定每周进行一次血液透析，并结合低蛋白饮食（0.6 g/kg/天），补充酮类似物（KAs）0.12 g/kg/天。在2-WHD组中，患者接受每周两次血液透析及常规蛋白饮食。主要结局是通过肾脏清除率和尿量评估的RKF变化。还评估了营养状况、肌肉参数和生活质量（QoL）。共有30例新发血液透析患者被随机分组。两组之间的基线RKF、尿量和人口统计学特征无差异。3个月后，1-WHD组的尿量显著高于2-WHD组（1921±767 mL/天 vs. 1305±599 mL/天，P = 0.02），并且这些显著差异在整个研究期间持续存在。对于RKF，1-WHD组的尿尿素（CUrea）和肌酐清除率（CCr）下降幅度也小于2-WHD组，在第6至12个月观察到统计学显著差异。到第6个月时，1-WHD组的CUrea和CCr显著高于2-WHD组，CUrea分别为3.2±2.3 vs. 1.7±1.0 mL/min（P = 0.03），CCr分别为5.9±3.6 vs. 3.8±1.4 mL/min（P = 0.04）。两组之间的血清白蛋白水平、骨骼肌质量、贫血状况、代谢参数、蛋白结合尿毒症毒素和QoL评分相当。与每周两次血液透析及常规蛋白饮食相比，从每周一次血液透析开始，结合补充KAs的蛋白质限制的增量血液透析似乎能更好地保留新发血液透析患者的RKF。这种血液透析方案在代谢和营养方面也具有安全性。
