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目的:观察有残肾功能患者每周2次和每周3次血液透析对残余肾功能的保护作用。方法:选取2017年1月至2019年12月在云南省第三人民医院血液净化中心治疗的有残余肾功能尿毒症患者212例,将其随机分为对照组102例和观察组110例。对照组每周血液透析3次,观察组每周透析2次。记录两组基线时和各随访点的残余肾功能、Kt/V、水平衡和化验指标,比较住院率、死亡率和卫生经济学。结果:12个月和24个月随访时观察组的eGFR、RRF和残肾Kt/V显著高于对照组(P<0.05);12个月和24个月随访时观察组周每次平均超滤量和净液体平衡显著低于对照组,而且观察组的24 h尿量比对照组大(P<0.05);随访期间,两组血红蛋白水平、血清白蛋白、钾和血磷水平比较,差异无统计学意义(P>0.05);两组死亡率和住院率比较:对照组(7.84%,8.82%)vs观察组(5.45%,10.00%),差异无统计学意义(P>0.05);观察组比对照组每年少透析费用24 960元,有卫生经济上的优势。结论:有RRF的尿毒症患者采用每周2次透析的初始处方具有保护RRF、防止透析间期体重过度增加和节省费用等优势。然而该方案不适合所有尿毒症患者,我们需要根据残余肾功能的变化制定出个体化血液透析方案。
Abstract：Objective:To investigate the renoprotective effect of twice-vs thrice-weekly hemodialysis in patients with residual renal function(RRF).Methods:A total of 212 uremicpatients with residual renal function treated in the Blood Purification Center ofYunnan Third Provincial People's Hospitalbetween January 2017 and December 2019 were enrolled and randomized into the control group(n= 102)and study group( n= 110).The control group received hemodialysis three times a week,while the study group received hemodialysis twice a week.The residual renal function,Kt/V,water balance and laboratory findings of the two groups at baseline and at each follow-up session were recorded. Hospital stay,mortality and health economics were compared between the two groups.Results:The values of eGFR,RRF and residual kidney Kt/V were significantly higher than in the study group than those in the control group at the 12 and 24 monthsduring follow-up,with statistically significant differences(P<0.05).At the 12 and 24 monthsduring follow-up,the average ultrafiltration volume and net fluid balance per session and week were significantly lower in the study group than those in the control group,and the 24-h urine volume was larger in the study group than that in the control group,with statistically significant differences.( P< 0. 05). During the follow-up,there were no statistically significant differences in levels of hemoglobin,serum albumin,potassium and phosphorus between the two groups( P> 0. 05). The mortality and hospitalization ratesin the control group and study group groups did not show statistically significant differences:7.84% vs 5.45%,and 8.82% vs 10.00%,respectively(P>0.05).The study group spentless by 24960 yuan on the hemodialysis per year compared with the control group,which was advantageous byhealth economics.Conclusion:Initial prescription of twice-weekly hemodialysis for uremic patients with RRF can be advantageous in terms ofRRF protection,reduction on excessive weight gain between hemodialysis,and cost-saving.However,this protocol may not be suitable for all patients with uremia.Personalizedprotocol of hemodialysis should be developed based on changes in RRF.
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基本信息:
中图分类号:R692.5
引用信息:
[1]张育安,陈波,吴成云.有残余肾功能患者每周2次和3次血液透析对残余肾功能保护作用的临床观察[J].广州医科大学学报,2021,49(04):93-98.
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