Mucsi I, Hercz G, Uldall R, Ouwendyk M, Francoeur R, Pierratos A
Wellesley Central Hospital, University of Toronto, Canada.
Kidney Int. 1998 May;53(5):1399-404. doi: 10.1046/j.1523-1755.1998.00875.x.
We compared the efficacy and the long-term effects of nocturnal hemodialysis (NHD) versus conventional hemodialysis (CHD) in controlling serum phosphate levels in patients with end-stage renal disease (ESRD). Patients underwent thrice weekly CHD and were subsequently switched to NHD six nights weekly. In the "acute" study serum and dialysate phosphate were measured during and after dialysis, and the total dialysate was collected to calculate mass solute removal. Although pre-dialysis (1.7 +/- 0.6 vs. 1.5 +/- 0.8 mM) serum phosphate levels were similar in CHD and NHD, respectively, post-dialysis levels were slightly lower with CHD (0.7 +/- 0.2 vs. 0.8 +/- 0.2 mM, P < 0.05). The measured phosphate removed per session of CHD or NHD was comparable, 25.3 +/- 7.5 versus 26.9 +/- 9.8 mumol/session, respectively. On the other hand, the cumulative weekly phosphate removal was significantly higher with NHD as compared to CHD, 75.8 +/- 22.5 versus 161.6 +/- 59.0 mumol/week (P < 0.01). In the "chronic" study serum phosphate levels were measured monthly for five months on CHD and for five months after the patients were switched to NHD. Dietary phosphate intake and the dosage of phosphate binders were tabulated. Serum phosphate levels fell during NHD: 2.1 +/- 0.5 mM at the beginning of the study and 1.3 +/- 0.2 mM five months after being switched to NHD (P < 0.001). At the same time dietary phosphate intake increased by 50%. By the fourth month of NHD therapy none of the patients was taking any phosphate binders. In conclusion, NHD is more effective in controlling serum phosphate levels than CHD, allowing patients to discontinue their phosphate binders completely and to ingest a more liberal diet.
我们比较了夜间血液透析（NHD）与传统血液透析（CHD）在控制终末期肾病（ESRD）患者血清磷酸盐水平方面的疗效和长期效果。患者每周接受三次CHD治疗，随后改为每周六个晚上进行NHD治疗。在“急性”研究中，在透析期间和透析后测量血清和透析液中的磷酸盐，并收集总透析液以计算溶质清除量。尽管CHD和NHD的透析前血清磷酸盐水平分别相似（1.7±0.6 vs. 1.5±0.8 mM），但CHD的透析后水平略低（0.7±0.2 vs. 0.8±0.2 mM，P < 0.05）。每次CHD或NHD治疗清除的测量磷酸盐量相当，分别为25.3±7.5与26.9±9.8 μmol/次。另一方面，与CHD相比，NHD的每周累积磷酸盐清除量显著更高，分别为75.8±22.5与161.6±59.0 μmol/周（P < 0.01）。在“慢性”研究中，在CHD治疗期间每月测量血清磷酸盐水平五个月，并在患者改为NHD治疗后五个月进行测量。记录饮食中磷酸盐摄入量和磷酸盐结合剂的剂量。在NHD治疗期间血清磷酸盐水平下降：研究开始时为2.1±0.5 mM，改为NHD治疗五个月后为1.3±0.2 mM（P < 0.001）。同时，饮食中磷酸盐摄入量增加了50%。到NHD治疗的第四个月，没有患者服用任何磷酸盐结合剂。总之，NHD在控制血清磷酸盐水平方面比CHD更有效，使患者能够完全停止服用磷酸盐结合剂并摄入更宽松的饮食。
