血液透析患者残余肾功能的变化及其影响因素

Study the factors that may influence the residual renal function in hemodialysis patients

目的探讨维持性血液透析患者残余肾功能(residual renal function,RRF)的变化及其影响因素。方法选择2005年9月至2010年2月北京大学人民医院血液净化中心新入的维持性血液透析患者74例,排除肿瘤、肾移植失功、腹膜透析转血液透析及随访时间少于1年的患者。尿量﹥100ml/24h者为有RRF,观察进入血液透析后RRF的变化并分析其影响因素。结果共44例患者入选。平均随访时间(26.42±14.40)个月,随着治疗时间的延长,RRF下降速率平均为(0.39±0.27)ml/(min·月),RRF下降速率快者[(0.72±0.22)ml/(min·月)]较下降慢者[(0.23±0.09)ml/(min·月)]肾脏存活率低,差异有统计学意义(t=9.124,P=0.000)。合并充血性心力衰竭者13例,占29.55%,平均2年后无RRF者8例,占32%,有RRF者5例,占26%,2组比较差异有统计学意义(掊2=45,P=0.000)。多元线形回归分析显示脱水量大、低白蛋白及收缩压增高是RRF下降的独立影响因素(R=0.915,R2=0.837)。结论尿毒症患者开始透析时容量负荷过重导致脱水量过大、透析不充分及血压控制不良,均不利于血液透析患者RRF的保护。

Objective To investigate the factors that influence RRF in hemodialysis （HD） patients. Methods Seventy-four incident HD patients with RRF were observed in Peking University People＇s Hospital between September 2005 and February 2010. Patients with a history of carcinoma, acute renal failure, renal transplantation, a history of PD or renal transplantion and time of follow-up for less than 1 year were excluded. Those patients with urine volumes less than 100 ml daily were classified as without RRF. The factors that may influence RRF were investigated in hemodialysis patients. Results A total of 44 patients were recruited in the study. The median follow-up time was （26.42± 14.40） months. The decline of RRF was （0.39±0.27） ml/（min .month）. Multivariate regression analysis showed that albumin, volume of ultrafiltration and blood pressure were independent determinants of RRF. The renal survival rate was higher in those patients with decreased ratio of RRF. Conclusions That preservation of residual renal function is important after initiating dialysis. Poor nutrition status, over-dehydration status and unsatisfactory arterial pressure control are independent risk factors for RRF preservation.