中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (05): 297-301.doi: 10.3969/j.issn.1671-4091.2021.05.003

• 临床研究 • 上一篇    下一篇

血液透析患者残余肾功能队列研究设计及初步结果

王梦婧1,2,黄碧红1,翁佳敏1,施君1,卢芳1,张炜晨1,王康杰1,张敏敏1,陈靖1,2   

  1. 1复旦大学附属华山医院肾内科
    2国家老年疾病临床医学研究中心(华山)
  • 收稿日期:2020-12-21 修回日期:2021-03-07 出版日期:2021-05-12 发布日期:2021-05-06
  • 通讯作者: 陈靖 chenjing1998@fudan.edu.cn E-mail:chenjing1998@fudan.edu.cn
  • 基金资助:

    上海市申康临床三年行动计划重大临床研究项目(SHDC2020CR4014)；

    国家自然科学基金青年基金(81600577)；

    上海市自然科学基金(16ZR1449400)；

    上海市医学领军人才培养计划(2019LJ03)；

    上海市科委创新行动计划项目(17411950701)

Huashan Residual Renal Function Cohort Study design and preliminary results

  1. 1Division of Nephrology, Huashan hospital, Fudan University, Shanghai 200040, China;
    2National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2020-12-21 Revised:2021-03-07 Online:2021-05-12 Published:2021-05-06

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摘要： 【摘要】目的调查维持性血液透析具有残余肾功能患者的流行病学特征；探讨影响残余肾功能的因素；研究残余肾功能评估生物学标志物；分析残余肾功能对远期预后的影响。方法维持性血液透析患者残余肾功能队列研究(Huashan Residual Kidney Function Cohort Study,HRKCS)是基于复旦大学附属华山医院门诊新入有残余肾功能维持性血液透析人群，具有医学数据库和生物样本资料的全样本前瞻性队列研究。2016 年1 月～2026 年12 月开展患者入组及随访。基线调查包括问卷访谈、体格检查、生化检测、残余肾功能检测和生物标本采集。随后对入组患者进行每3 个月1 次随访，采集透析、生化及转归数据。结果自2016 年1 月～2020 年1 月入组患者46 名，平均年龄为(61±18)岁，男性占50%，起始透析频率2 次/w 占57%，该部分患者在平均1.2 年随访期间，46%由2 次/w 透析逐步过渡到3 次/w。所有患者初始尿素氮清除率为(3.37±2.16)ml/(min·1.73m2)，1 年后的尿素氮清除率逐步下降至(1.81±2.05)
ml/(min·1.73m2)(Z=-5.924，P＜0.001)。所有患者第一年的透析并发症指标控制均稳定，在平均1.8 年随访期间，死亡率为1.2/100 人年，心血管事件发生率为8.5/100 人年。结论维持性血液透析残余肾功能队列57%采用递增透析方案，残余肾功能下降速度延缓，并发症控制理想，全因死亡风险低。本研究将提供中国维持性血液透析残余肾功能相关数据资料及生物样本资源，为残余肾功能研究提供基础数据和决策依据。

关键词: 维持性血液透析, 残余肾功能, 队列研究

Abstract: 【Abstract】Objective To investigate the characteristics of maintenance hemodialysis patients with residual renal function (RRF), explore the influencing factors and biomarkers of RRF, and analyze the association of RRF on prognosis. Methods Huashan Residual Kidney Function Cohort Study (HRKCS) enrolled incident hemodialysis patients with RRF in out- patient clinic with a prospective cohort design. The enrollment and follow-up are conducted between January 2016 and December 2026. Questionnaire interview, physical examination, biochemical testing, RRF measurement, biological specimen collection, and outcome are included
in the baseline or follow-up survey. Results Forty-six incident patients were enrolled between January 2016 and January 2020. The average age of enrolled patients was (61±18) years old, with 50% males. 57 % of them were treated with 2 times/week hemodialysis. During a median follow-up of 1.2 years, 46% of patients with 2 time/week hemodialysis changed their hemodialysis frequency from 2 times/week to 3 times/week. All enrolled patients had an average initial urea nitrogen clearance rate of (3.37± 2.16) ml/(min·1.73m2) (Z=-5.924, P＜0.001), which decreased to (1.81±2.05)ml/(min·1.73m2) after onEyear hemodialysis. All patients had stable control of complications in the first year. During the average follow-up period of 1.8 years, the mortality rate was 1.2/100 person-years, and the incidence of cardiovascular events was 8.5/100 person-years. Conclusion 57% of the patients in this cohort initiated with incremental dialysis, which had benefits to delay the decline of residual renal function, control the complications, and decrease the risk of all-cause death. HRKCS establishes a fundamental database and guidance for RRF studies.

Key words: Maintenance Hemodialysis, Residual Renal Function, Cohort Study

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