苯磺酸氨氯地平对维持性血液透析患者残余肾功能的影响

The effect of amlodipine on residual renal function in maintenance hemodialysis patients

目的使用不同类型的降压药物,在对维持性血液透析患者进行降压治疗的同时,对比观察其对维持性血液透析患者残余肾功能、电解质及心血管事件的影响,从而探讨适合维持性血液透析患者的降压治疗方案。方法采用单中心前瞻性研究,纳入本院血液透析中心符合入选标准的维持性血液透析患者共60例。将其分为使用苯磺酸氨氯地平(A组)、使用硝苯地平或非洛地平(B组)、使用血管紧张素受体抑制剂(ARB)及血管紧张素转化酶抑制剂(ACEI)药物(C组)3组,观察时间18个月,定期检测各项血生化指标、尿量,记录心血管事件发生率并计算Kt/V及残余肾功能。结果治疗前3组患者各项指标比较差异均无统计学意义(P>0.05)。研究结束时,3组患者残余肾功能均有下降,其中,B组下降最明显(P<0.05)。尿量和脱水量方面比较,B组尿量减少最快,超滤量增加最多(P<0.05),其余两组间比较差异无统计学意义(P>0.05)。高钾血症发生率及心血管事件发生率方面比较,C组均为最高,但差异无统计学意义(P>0.05)。结论相较于其他类型的CCB药物,苯磺酸氨氯地平有更好保护维持性血液透析患者残余肾功能及尿量的作用。

Objective To compare the effect of different types of anti-hypertensive drugs on residue renal function of main-tainance hemodialysis patients,electrolytes and cardio-renal events,and to determine appropriate anti-hypertensive therapy for MHD patients. Methods This was a single center cohort study. A total of 60 MHD patients in our hemodialysis center were enrolled,and divided to three groups using amlodipine only, Nifedipine/felodipine only and RAS inhibitors respoctively. The follow-up was 18 months. Biochemical parameters and urine volume were measured regularly. We recorded cardiovascular events and calculated Kt/V and residue renal function. Results There was no difference in baseline parameters among these three groups（P〉0. 05）. At the end of the study, the residue renal function in three groups all decreased,among which the Nifedipine group has the lowest level（P〈0.05）. For urine volume and ultrafiltration volume,Nifedipine group has the mostly decrased urine volume and mostly increased（P〈0.05）. Ultrafihration volume,and there no difference between the other 2 groups（P〉0.05）. The incidene of hyperkalemia and cardiovascular events was the highest in RAS group（P〈0.05）, but the different had no statistical significance（P〉0.05）. Conclusion Amlodipine has a benefit to protect the residue renal function and urine volume of patient compared to other types of calcium channel blockers.