中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (07): 362-366.doi: 10.3969/j.issn.1671-4091.2013.07.00

• 临床研究 • 上一篇    下一篇

不除水对新的血液透析患者残余肾功能的影响

刘莎1,刁宗礼2,张东亮3,丁嘉祥4,崔文英2,刘文虎2   

  1. 1. 北京友谊医院 肾内科
    2. 首都医科大学附属北京友谊医院
    3. 首都医科大学附属北京友谊医院肾内科
    4. 首都医科大学北京友谊医院
  • 收稿日期:2013-01-08 修回日期:2013-04-19 出版日期:2013-07-12 发布日期:2013-07-06
  • 通讯作者: 刘文虎 E-mail:liuwh2002@yahoo.cn,liusha_sid@yahoo.com.cn

Preservation of residual renal function by not removing water in new hemodialysis patients

  • Received:2013-01-08 Revised:2013-04-19 Online:2013-07-12 Published:2013-07-06

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摘要： 目的 观察透析不除水( no water removal , NWR) 对于新的血液透析患者残余肾功能的影响。方法 入选56名日尿量≥1000 ml的新透析患者，将患者随机分为NWR组和除水（water removal, WR)组，随访6个月。如果透析前血压>150/90 mmHg, 给予口服降压药控制血压。首要终点包括死亡，心脑血管事件，顽固性高血压，浮肿或辅助检查提示明显液体潴留。次要终点为少尿。记录尿量，24小时尿肌酐清除率，降压药限定日剂量（the defined daily dose ,DDD) 指数，计算促红细胞生成素抵抗指数，心胸比和左心室重量指数（left ventricular mass index ,LVMI) 。 结果 NWR组8名患者到达首要终点，WR组9名患者到达次要终点。与WR组相比，随访结束时NWR组患者收缩压(9.0 ± 8.3 vs. -2.4 ± 2.0 mmHg, p<0.001)，DDD指数(1.2 ± 1.02 vs. -0.9 ± 0.51, p< 0.001)，尿量(164 ± 351 vs. -726 ± 342 ml, p<0.001)， 心胸比(0.02 ± 0.04 vs. -0.03 ± 0.03, p<0.001)和LVMI(9.6 ± 17.0 vs. -12.0 ± 21.4 g/m2, p<0.001)增加更明显，肌酐清除率下降更缓慢(-1.0 ± 0.4 vs. -2.0 ± 1.0, p<0.001)。结论 NWR对新的血液透析患者的残余肾功能有保护作用，但NWR并不适合所有的患者。

关键词: 残余肾功能, 除水, 血液透析

Abstract: Objective To investigate the effect of no water removal (NWR) on preservation of residual renal function (RRF) in new hemodialysis patients. Methods Fifty-six patients with a daily urine volume ≥1000 ml were included. Patients were randomized to different fluid management groups of NWR or water removal (WR) for 6 months. If predialysis BP was >150/90 mmHg, patients could take antihypertensive drugs. The primary endpoints included death, cardio-cerebral vascular disease, refractory hypertension, and edema or an auxiliary examination indicating obvious fluid retention. The secondary endpoint was oliguria. A daily urine volume, 24-h urine creatinine clearance, the defined daily dose (DDD) index of antihypertensive drugs, erythropoietin resistance index, cardiothoracic ratio, and left ventricular mass index (LVMI) were recorded. Results Eight patients in the NWR group reached the primary endpoints. Nine patients in the WR group reached the secondary endpoint. At the end of the study, patients in the NWR group had more increased systemic blood pressure (9.0 ± 8.3 vs. -2.4 ± 2.0 mmHg, p<0.001), DDD index (1.2 ± 1.02 vs. -0.9 ± 0.51, p< 0.001), daily urine volume (164 ± 351 vs. -726 ± 342 ml, p<0.001), cardiothoracic ratio (0.02 ± 0.04 vs. -0.03 ± 0.03, p<0.001), LVMI (9.6 ± 17.0 vs. -12.0 ± 21.4 g/m2, p<0.001), and less decreased urine creatinine clearance (-1.0 ± 0.4 vs. -2.0 ± 1.0, p<0.001), compared with those patients in the WR group. Conclusions Preservation of RRF by NWR is warranted in new HD patients, but is not appropriate for all patients.

Key words: Residual renal function, water removal, hemodialysis