Van Stone J C
University of Missouri Medical School, Dialysisi Clinics Inc., Columbia 65201, USA.
ASAIO J. 1995 Jul-Sep;41(3):M713-6. doi: 10.1097/00002480-199507000-00105.
It is commonly believed that renal function rapidly decreases in the vast majority of chronic hemodialysis patients. Three hundred thirty-four patients starting chronic hemodialysis between 1/1/88 and 12/31/92 at six hemodialysis units were prospectively studied. Renal function was determined every 3 months by 68 hr urine collection expressed as weekly fraction urea clearance (L/L total body water/wk). glomerular filtration rate was calculated from the mean of the urea and creatinine clearance. After 3 years, glomerular filtration rate exceeded 4 ml/min in 14% of patients. For a thrice weekly dialysis schedule, it was assumed that a weekly fractional urea clearance of 3 L/L/wk is equal to a dialysis KT/V of 1 and patients need a minimum KT/V of 1.2 per treatment. After 3 years of chronic hemodialysis therapy, residual renal function was found to provide 15% of the dialysis requirement in 19% of patients and 30% of the dialysis requirements in 9% of patients. The occasional patient maintains sufficient residual renal function to provide over 40% of the dialysis requirement for over 4 years. In a retrospective analysis, patients treated only with Cupraphan membrane had a more rapid loss of renal function compared to those never treated with Cupraphan (Besnberg Corp., Germany). The majority of patients with polycystic kidney disease maintained a glomerular filtration rate greater than 2 ml/min for 4 years or longer.
人们普遍认为，绝大多数慢性血液透析患者的肾功能会迅速下降。对1988年1月1日至1992年12月31日期间在六个血液透析单位开始进行慢性血液透析的334例患者进行了前瞻性研究。每3个月通过收集68小时尿液来测定肾功能，以每周尿素清除率（升/升总体液/周）表示。肾小球滤过率由尿素清除率和肌酐清除率的平均值计算得出。3年后，14%的患者肾小球滤过率超过4毫升/分钟。对于每周三次的透析方案，假定每周尿素清除率为3升/升/周相当于透析KT/V为1，且患者每次治疗所需的最低KT/V为1.2。经过3年的慢性血液透析治疗后，发现19%的患者残余肾功能可满足15%的透析需求，9%的患者可满足30%的透析需求。偶尔有患者能维持足够的残余肾功能，在超过4年的时间里满足超过40%的透析需求。在一项回顾性分析中，与从未使用过铜仿膜（德国贝斯贝格公司）的患者相比，仅使用铜仿膜进行治疗的患者肾功能丧失更快。大多数多囊肾病患者的肾小球滤过率在4年或更长时间内维持在大于2毫升/分钟。
