中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 1045-1048.doi: 10.3969/j.issn.1671-4091.2025.12.017

• 护理研究 • 上一篇    

血液透析滤过患者的症状困扰现状及与透析剂量的关系

方李君  刘婷婷  傅钰淇  赵 丹  方妮娜  庞慧华  陆任华  顾乐怡  章海芬   

  1. 200127 上海，上海交通大学医学院附属仁济医院1护理部 3肾内科
    201318 上海，2上海健康医学院护理与健康管理学院
  • 收稿日期:2025-06-30 修回日期:2025-10-12 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 章海芬 E-mail:haifenzhang@163.com
  • 基金资助:
    上海市“科技创新行动计划”国际科技合作项目(24410790500)；上海市闵行区自然科学研究课题(2023MHZ021)

Symptom burden in hemodiafiltration patients and its relationship with dialysis dose

FANG Li-jun, LIU Ting-ting, FU Yu-qi, ZHAO Dan, FANG Ni-na, PANG Hui-hua, LU Ren-hua, GU Le-yi, ZHANG Hai-fen   

  1. Department of Nursing and 3Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China; 2School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
  • Received:2025-06-30 Revised:2025-10-12 Online:2025-12-12 Published:2025-12-12
  • Contact: 200127 上海，上海交通大学医学院附属仁济医院1护理部 E-mail:haifenzhang@163.com

摘要： 目的  调查血液透析滤过(hemodiafiltration,HDF)患者的症状困扰现状，并分析其与HDF透析剂量之间的关系。 方法  采用横断面研究设计，选取2024年11月—2025年1月接受每周3次规律血液透析，且每周至少1次后稀释HDF治疗的维持性血液透析患者。收集患者的一般资料、HDF治疗参数和实验室指标，使用透析症状指数(dialysis symptom index,DSI)量表评估患者症状困扰情况，分析其与HDF透析剂量的关系。 结果  共纳入179例患者，DSI总分为12.00(9.00,17.00)分。发生率最高的5种症状分别为皮肤干燥(89.94%)、瘙痒(81.56%)、口干(81.01%)、易惊醒(76.53%)、乏力(68.72%)。症状最严重的前5项分别为易惊醒[2.00(1.00,2.00)分]、入睡困难[1.00(0.00,2.00)分]、皮肤干燥[1.00(1.00,2.00)分]、瘙痒[1.00(1.00,2.00)分]、口干[1.00(1.00,2.00)分]。HDF周对流量为41.44(35.01,53.76)L。随着HDF治疗频率增加，周对流量和β2-微球蛋白下降率上升(H=122.516、24.138，均P＜0.001)，透析前β2-微球蛋白水平降低(H=20.903,P＜0.001)。每周接受2次（Z=-2.388,P=0.017）或3次（Z=-2.182,P=0.029）HDF治疗的患者，其DSI总分均低于每周1次者。局部加权回归分析显示：当周对流量超过51.94 L后，患者症状困扰呈下降趋势。 结论  HDF治疗的患者普遍存在症状困扰，但随着HDF透析剂量的增加而有所改善，这可能得益于HDF对中分子毒素的清除。临床实践中提升HDF透析剂量可能有助于改善患者症状体验、优化长期治疗结局。

关键词: 血液透析滤过, 症状困扰, 透析剂量, 患者报告结局

Abstract: Objective To investigate the symptoms occurred in patients receiving hemodiafiltration (HDF), and to analyze the relationship between the symptoms and HDF dose.  Methods  This was a cross-sectional study. Patients receiving regular maintenance hemodialysis thrice a week as well as post-diluted HDF at least once a week between November 2024 and January 2025 were recruited. Patients’ general data, HDF information and laboratory examinations were collected. Symptom burden was assessed using the Dialysis Symptom Index (DSI). The relationship between symptom burden and HDF dose was analyzed.  Result  A total of 179 patients were included in this study. The total DSI was 12.00 (9.00, 17.00) points. The first 5 most common symptoms were dry skin (89.94%), itching (81.56%), dry mouth (81.01%), feeling irritable (76.53%) and fatigue (68.72%). The first 5 most severe symptoms were irritable feeling [2.00 (1.00, 2.00) points], difficult falling asleep [1.00 (0.00, 2.00) points], dry skin [1.00 (1.00, 2.00) points], itching [1.00 (1.00, 2.00) points], and dry mouth [1.00 (1.00, 2.00) points]. The weekly convective volume of HDF was 41.44 (35.01, 53.76) L. With the increase of HDF frequency, weekly convective volume and β2-microglobulin reduction rate increased (H=122.516 and 24.138, P<0.001), accompanied by the decrease of pre-treatment β2-microglobulin levels (H=20.903, P<0.001). Patients receiving HDF therapy twice weekly(Z=-2.388，P=0.017) or thrice weekly (Z=-2.182, P=0.029) demonstrated lower total DSI scores compared to those receiving therapy once weekly. Locally weighted regression analysis showed that when convection volume is over 51.94 L/week, patients' DSI showed a downward trend.  Conclusion  Patients receiving HDF often experience a considerable symptom burden. The symptom burden can be improved with the increase of HDF dose, which is probably attributed to the clearance of medium molecular toxins. Higher HDF dose may improve patient’s symptom experience and long-term outcomes.

Key words: Hemodiafiltration, Symptom burden, Dialysis dose, Patient reported outcome

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