Pierratos A, Ouwendyk M, Francoeur R, Vas S, Raj D S, Ecclestone A M, Langos V, Uldall R
Wellesley Central Hospital, Toronto, Ontario, Canada.
J Am Soc Nephrol. 1998 May;9(5):859-68. doi: 10.1681/ASN.V95859.
There is evidence that high frequency, as well as long duration, hemodialysis provides better clinical outcomes. We developed nocturnal hemodialysis, a new innovative form of renal replacement therapy, which is performed six to seven nights per week for 8 to 10 h during sleep at home. Blood flow was set at 300 ml/min and dialysate flow at 100 ml/min. An internal jugular catheter was used as the vascular access. Special precautions were taken to prevent accidental disconnection during sleep, as well as air embolization. Dialysis functions from the patient's home were monitored continuously via a modem at the nocturnal hemodialysis center. Twelve patients have completed training and have been successfully performing nocturnal hemodialysis for up to 34 mo. This study represents 170 patient months of experience accumulated over 3 yr. There was hemodynamic stability and significant subjective improvement in patient well being. Nightly Kt/V was 0.99. Weekly removal of phosphate was twice as high and beta2 microglobulin 4 times as high as conventional hemodialysis. All patients have discontinued their phosphate binders and have increased dietary phosphate and protein intake. BP control was achieved with fewer medications. Dialyzer reuse has decreased the operating costs to the level of the other form of home dialysis. Complications were infrequent and were related primarily to the dialysis access. Nocturnal hemodialysis represents the most efficient form of dialysis at low cost and should be considered as an option for patients who can be trained for home hemodialysis.
有证据表明，高频以及长时间的血液透析能带来更好的临床效果。我们开发了夜间血液透析，这是一种新型的肾脏替代治疗方式，每周进行六到七个晚上，在家睡眠期间进行8至10小时。血流量设定为300毫升/分钟，透析液流量为100毫升/分钟。使用颈内静脉导管作为血管通路。采取了特殊预防措施以防止睡眠期间意外断开连接以及空气栓塞。通过夜间血液透析中心的调制解调器持续监测患者家中的透析功能。12名患者已完成培训，并已成功进行夜间血液透析长达34个月。本研究代表了3年累积的170个患者月的经验。患者的血流动力学稳定，主观幸福感有显著改善。夜间的Kt/V为0.99。每周的磷清除量是传统血液透析的两倍，β2微球蛋白清除量是其四倍。所有患者都已停用磷结合剂，并增加了饮食中的磷和蛋白质摄入量。使用较少的药物即可实现血压控制。透析器复用已将运营成本降低到其他家庭透析形式的水平。并发症很少见，主要与透析通路有关。夜间血液透析是成本低廉的最有效透析形式，对于能够接受家庭血液透析培训的患者应考虑将其作为一种选择。
