夜间血液透析改善血液透析患者贫血治疗
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摘要
目的比较夜间血液透析(nocturnal hemodialysis,NHD)相对于传统血液透析(conventional hemodialysis,CHD)对血液透析患者贫血治疗的影响。方法收集自2009年2月至2017年12月在海军军医大学附属长征医院透析的26例NHD患者,其中21例由CHD更改为NHD,匹配患者性别、年龄、初始血红蛋白水平等标准,按照时间先后顺序选出60例CHD患者作为对照组,比较两组透析患者的一般情况、铁蛋白、转铁蛋白饱和度、C反应蛋白(C-reactive protein,CRP)等指标及透析间促红细胞生成素(erythropoieth,EPO)用量、铁剂用量、输血事件发生率等差异。结果 NHD与CHD组在入选时基线状态的CRP、铁蛋白与转铁蛋白饱和度均无显著差异(P>0.05),NHD组随访末次的EPO用量低于CHD组(103.4±53.6 IU·kg~(-1)·w~(-1)vs 126.34±54.9 IU·kg~(-1)·w~(-1),P<0.05),NHD组随访末次的血红蛋白高于CHD组,且NHD组静脉铁剂使用率低于CHD组,两组间CRP、铁蛋白、转铁蛋白饱和度无显著性差异。更换透析模式治疗的21例患者,随访末次血红蛋白水平高于基线值血红蛋白水平(P<0.05),铁蛋白、转铁蛋白饱和度、CRP无显著性差异(P>0.05),平均EPO用量与更换模式治疗前1年比较未见明显差异(106±34.6 IU·kg~(-1)·w~(-1)vs 110±30.9 IU·kg~(-1)·w~(-1))。结论夜间透析与传统血液透析相比,减少患者EPO及静脉铁剂的剂量,对透析患者的贫血控制效果更加完善。
Objective To compare effect of nocturnal hemodialysis(NHD) versus conventional hemodialysis(CHD) on anemia treatment in hemodialysis patients, to investigate whether the treatment of anemia was improved in patients receiving of nocturnal hemodialysis(NHD) when compared with conventional hemodialysis(CHD). Methods A total of 39 patients with NHD undergoing dialysis in Chang zheng Hospital, Naval Military Medical University from February 2009 to December 2017, were selected, of which 21 patients with CHD were changed into those with NHD. By matching gender, age and initial hemoglobin levels of patients, based on time sequence, 60 patients with CHD were selected. General condition, ferritin, transferrin saturation, C-reactive protein(CRP), and the interdialytic doses of and ferric preparation and transfusion event rate were compared between the patients in the two groups. Results There was no significant difference in CRP, ferratin and transferrin saturation at baseline between the NHD and CHD groups during enrollment(P>0.05). The EPO dose at the final follow-up in the NHD group was lower than that in the CHD group(103.4±53.6 IU·kg~(-1)·w~(-1) vs 126.34±54.9 IU·kg~(-1)·w~(-1), P<0.05), and the ferric preparation use rate in the NHD group was lower than that in the CHD group. There was no significant difference between the two groups in CRP, ferratin and transferrin saturation between the two groups. For those 21 patients who changed dialysis model, the hemoglobin level at the final follow-up was higher than that at baseline(P<0.05); the ferritin, transferrin saturation and CRP had no significant difference from those before changing the dialysis model(P>0.05); and the mean EPO dose had no significant difference compared to that at 1 year before changing the treatment model(106±34.6 IU·kg~(-1)·w~(-1) vs 110±30.9 IU·kg~(-1)·w~(-1)). Conclusions Compared with conventional hemodialysis, nocturnal hemodialysis can reduce the doses of EPO and intravenous ferric preparation in dialysis patients, and achieve the improved control of anemia in hemodialysis patients.
Objective To compare effect of nocturnal hemodialysis(NHD) versus conventional hemodialysis(CHD) on anemia treatment in hemodialysis patients, to investigate whether the treatment of anemia was improved in patients receiving of nocturnal hemodialysis(NHD) when compared with conventional hemodialysis(CHD). Methods A total of 39 patients with NHD undergoing dialysis in Chang zheng Hospital, Naval Military Medical University from February 2009 to December 2017, were selected, of which 21 patients with CHD were changed into those with NHD. By matching gender, age and initial hemoglobin levels of patients, based on time sequence, 60 patients with CHD were selected. General condition, ferritin, transferrin saturation, C-reactive protein(CRP), and the interdialytic doses of and ferric preparation and transfusion event rate were compared between the patients in the two groups. Results There was no significant difference in CRP, ferratin and transferrin saturation at baseline between the NHD and CHD groups during enrollment(P>0.05). The EPO dose at the final follow-up in the NHD group was lower than that in the CHD group(103.4±53.6 IU·kg~(-1)·w~(-1) vs 126.34±54.9 IU·kg~(-1)·w~(-1), P<0.05), and the ferric preparation use rate in the NHD group was lower than that in the CHD group. There was no significant difference between the two groups in CRP, ferratin and transferrin saturation between the two groups. For those 21 patients who changed dialysis model, the hemoglobin level at the final follow-up was higher than that at baseline(P<0.05); the ferritin, transferrin saturation and CRP had no significant difference from those before changing the dialysis model(P>0.05); and the mean EPO dose had no significant difference compared to that at 1 year before changing the treatment model(106±34.6 IU·kg~(-1)·w~(-1) vs 110±30.9 IU·kg~(-1)·w~(-1)). Conclusions Compared with conventional hemodialysis, nocturnal hemodialysis can reduce the doses of EPO and intravenous ferric preparation in dialysis patients, and achieve the improved control of anemia in hemodialysis patients.
引文
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[15] Li S,Collins AJ.Association of hematocrit value with cardiovascular morbidity and mortality in incident hemodialysis patients [J].Kidney Int,2004,65(2):626-633.
[16] Nitta K.Clinical assessment and management of dyslipidemia in patients with chronic kidney disease [J].Clin Exp Nephrol,2012,16(4):522-529.
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[18] Rao M,Muirhead N,Klarenbach S,et al.Management of anemia with quotidian hemodialysis[J].Am J Kidney Dis,2003,42(1):18-23.
[19] Ok E,Duman S,Asci G,et al.Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-center hemodialysis:a prospective,case-controlled study [J].Nephrol Dial Transplant,2011,26(4):1287-1296.
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[22] Jin X,Rong S,Mei C,et al.Effects of thrice-weekly in-center nocturnal vs.conventional hemodialysis on integrated backscatter of myocardial tissue [J].Hemodial Int,2011,15(2):200-210.
[23] Jin X,Rong S,Mei C,et al..Effects of in-center nocturnal versus conventional hemodialysis on endothelial dysfunction [J].Ther Apher Dial,2012,16(4):334-340.
[24] Weinreich T,De los Rios T,Gauly A,et al.Effects of an increase in time vs.frequency on cardiovascular parameters in chronic hemodialysis patients [J].Clin Nephrol,2006,66(6):433-439.
[25] Powell JR,Oluwaseun O,Woo YM,et al.Ten years experience of in-center thrice weekly long overnight hemodialysis[J].Clin J Am Soc Nephrol,2009,4(6):1097-1101.
[26] David S,Kumpers P,Eisenbach GM,et al.Prospective evaluation of an in-centre conversion from conventional hemodialysis to an intensified nocturnal strategy[J].Nephrol Dial Transplant,2009,24(7):2232-2240.
[27] Alloatti S,Molino A,Manes M,et al.Long nocturnal dialysis[J].Blood Purif,2002,20(6):525-530.
[28] Gubensek J,Buturovic-Ponikvar J,Knap B,et al.Effect of switching to nocturnal thrice-weekly hemodialysis on clinical and laboratory parameters:our experience[J].Ther Apher Dial,2013,17(4):412-415.
[29] Graham-Brown MP,Churchward DR,Smith AC,et al.A 4-month program of in-center nocturnal hemodialysis was associated with improvements in patient outcomes[J].Clin Kidney J,2015,8(6):789-795.
[30] Dai WD,Zhang DL,Cui WY,et al.Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients[J].Chin Med J ,2013,126(24):4655-4659.
[31] Fajardo L,Campistrus N,Rios P,et al.Evolution of serum phosphate in long intermittent hemodialysis [J].Kidney Int suppl,2003,85:S66-68.
[32] Bugeja A,Dacouris N,Thomas A,et al.In-center nocturnal hemodialysis:another option in the management of chronic kidney disease [J].Clin J Am Soc Nephrol,2009,4(4):778-783.
[33] Galli F,Beninati S,Benedetti S,et al.Polymeric protein-polyamine conjugates:a new class of uremic toxins affecting erythropoiesis [J].Kidney Int Suppl,2001,78(13):S73-76.
[34] Macdougall IC.Role of uremic toxins in exacerbating anemia in renal failure[J].Kidney Int Suppl,2001,78(24):S67-72.
[35] Goldfarb-Rumyantzev AS,Cheung AK,Leypoldt JK.Computer simulation of small-solute and middle-molecule removal during short daily and long thrice-weekly hemodialysis[J].Am J Kidney Dis,2002,40(6):1211-1218.
[36] Rioux JP,Chan CT.Nocturnal home hemodialysis and its impact on erythropoietin responsiveness[J].Clin Nephrol,2010,74(3):167-172.
[2] Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey [J].Lancet,2012,379(9818):815-822.
[3] Ng YH,Meyer KB,Kusek JW,et al.Hemodialysis timing,survival,and cardiovascular outcomes in the Hemodialysis (HEMO) Study [J].Am J Kidney Dis,2006,47(4):614-624.
[4] Jansz TT,Bonenkamp AA,Boereboom FTJ,et al.Health-related quality of life compared between kidney transplantation and nocturnal hemodialysis[J].PLoS One,2018,13(9):415-416.
[5] Li L,Tang X,Kim S,et al..Effect of nocturnal hemodialysis on sleep parameters in patients with end-stage renal disease:a systematic review and meta-analysis [J].PLoS One,2018,13(9):371-374.
[6] Wong B,Collister D,Muneer M,et al.In-Center Nocturnal Hemodialysis Versus Conventional Hemodialysis:A Systematic Review of the Evidence [J].Am J Kidney Dis,2017,70(2):218-234.
[7] Luik AJ,Charra B,Katzarski K,et al.Blood pressure control and hemodynamic changes in patients on long time dialysis treatment [J].Blood Purif,1998,16(4):197-209.
[8] Basile C,Libutti P,Di Turo AL,et al.Hemodynamic stability in standard bicarbonate hemodialysis and long-hour slow-flow bicarbonate haemodialysis[J].Nephrol Dial Transplant,2011,26(1):252-258.
[9] Hanly PJ,Pierratos A.Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis[J].N Engl J Med,2001,344(2):102-107.
[10] Lindsay RM,Alhejaili F,Nesrallah G,et al.Calcium and phosphate balance with quotidian hemodialysis [J].Am J Kidney Dis,2003,42(1):24-29.
[11] McFarlane PA.Nocturnal hemodialysis:effects on solute clearance,quality of life,and patient survival [J].Curr Opin Nephrol Hypertens,2011,20(2):182-188.
[12] 康梅子,薛澄,付莉莉,等.中心夜间透析和传统透析患者循环成纤维细胞生长因子23水平差异及影响因素[J].第二军医大学学报,2017,38(1):27-33.
[13] Eckardt KU.Anemia in end-stage renal disease:pathophysiological considerations [J].Nephrol Dial Transplant,2001,16 (7):2-8.
[14] Zalunardo N,Levin A.Anemia and the heart in chronic kidney disease [J].Semin Nephrol,2006,26(4):290-295.
[15] Li S,Collins AJ.Association of hematocrit value with cardiovascular morbidity and mortality in incident hemodialysis patients [J].Kidney Int,2004,65(2):626-633.
[16] Nitta K.Clinical assessment and management of dyslipidemia in patients with chronic kidney disease [J].Clin Exp Nephrol,2012,16(4):522-529.
[17] Furuhashi M,Ishimura S,Ota H,et al.Serum fatty acid-binding protein 4 is a predictor of cardiovascular events in end-stage renal disease [J].PLoS One,2011,6(11):234-256.
[18] Rao M,Muirhead N,Klarenbach S,et al.Management of anemia with quotidian hemodialysis[J].Am J Kidney Dis,2003,42(1):18-23.
[19] Ok E,Duman S,Asci G,et al.Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-center hemodialysis:a prospective,case-controlled study [J].Nephrol Dial Transplant,2011,26(4):1287-1296.
[20] Lacson E Jr.Wang W,Lester K,et al.Outcomes associated with in-center nocturnal hemodialysis from a large multicenter program[J].Clin J Am Soc Nephrol,2010,5(2):220-226.
[21] Wald R,Goldstein MB,Perl J ,et al.The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients with End-Stage Renal Disease [J].Can J Cardiol,2016,32(3):369-377.
[22] Jin X,Rong S,Mei C,et al.Effects of thrice-weekly in-center nocturnal vs.conventional hemodialysis on integrated backscatter of myocardial tissue [J].Hemodial Int,2011,15(2):200-210.
[23] Jin X,Rong S,Mei C,et al..Effects of in-center nocturnal versus conventional hemodialysis on endothelial dysfunction [J].Ther Apher Dial,2012,16(4):334-340.
[24] Weinreich T,De los Rios T,Gauly A,et al.Effects of an increase in time vs.frequency on cardiovascular parameters in chronic hemodialysis patients [J].Clin Nephrol,2006,66(6):433-439.
[25] Powell JR,Oluwaseun O,Woo YM,et al.Ten years experience of in-center thrice weekly long overnight hemodialysis[J].Clin J Am Soc Nephrol,2009,4(6):1097-1101.
[26] David S,Kumpers P,Eisenbach GM,et al.Prospective evaluation of an in-centre conversion from conventional hemodialysis to an intensified nocturnal strategy[J].Nephrol Dial Transplant,2009,24(7):2232-2240.
[27] Alloatti S,Molino A,Manes M,et al.Long nocturnal dialysis[J].Blood Purif,2002,20(6):525-530.
[28] Gubensek J,Buturovic-Ponikvar J,Knap B,et al.Effect of switching to nocturnal thrice-weekly hemodialysis on clinical and laboratory parameters:our experience[J].Ther Apher Dial,2013,17(4):412-415.
[29] Graham-Brown MP,Churchward DR,Smith AC,et al.A 4-month program of in-center nocturnal hemodialysis was associated with improvements in patient outcomes[J].Clin Kidney J,2015,8(6):789-795.
[30] Dai WD,Zhang DL,Cui WY,et al.Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients[J].Chin Med J ,2013,126(24):4655-4659.
[31] Fajardo L,Campistrus N,Rios P,et al.Evolution of serum phosphate in long intermittent hemodialysis [J].Kidney Int suppl,2003,85:S66-68.
[32] Bugeja A,Dacouris N,Thomas A,et al.In-center nocturnal hemodialysis:another option in the management of chronic kidney disease [J].Clin J Am Soc Nephrol,2009,4(4):778-783.
[33] Galli F,Beninati S,Benedetti S,et al.Polymeric protein-polyamine conjugates:a new class of uremic toxins affecting erythropoiesis [J].Kidney Int Suppl,2001,78(13):S73-76.
[34] Macdougall IC.Role of uremic toxins in exacerbating anemia in renal failure[J].Kidney Int Suppl,2001,78(24):S67-72.
[35] Goldfarb-Rumyantzev AS,Cheung AK,Leypoldt JK.Computer simulation of small-solute and middle-molecule removal during short daily and long thrice-weekly hemodialysis[J].Am J Kidney Dis,2002,40(6):1211-1218.
[36] Rioux JP,Chan CT.Nocturnal home hemodialysis and its impact on erythropoietin responsiveness[J].Clin Nephrol,2010,74(3):167-172.