递增式血液透析和残余肾功能

Incremental hemodialysis and residual kidney function

残余肾功能是肾脏受损后健存肾单位的滤过、重吸收和内分泌功能,它不仅可以维持水、电解质和酸碱平衡,还可清除小分子、中分子和蛋白结合类毒素,与血液透析患者的预后息息相关。当前,残余肾功能的主要评估方法为尿素氮清除率。对于有残余肾功能的血液透析患者,应该结合残余肾功能水平采用标准尿素清除指数(standard Kt/Vurea,stdKt/Vurea)对患者的透析充分性进行综合评估。近年来,递增式血液透析作为保护残余肾功能的方式之一备受关注。递增式血液透析是指根据患者残余肾功能由低至高逐渐增加血液透析剂量的透析模式。当前研究发现递增式血液透析不仅可以保护残余肾功能,同时可改善患者生活质量、优化贫血管理、降低血β2微球蛋白,甚至改善患者远期生存。然而,递增式血液透析的实施方案目前还需要更多研究予以完善。

Residual kidney function plays critical roles in controlling water,electrolyte and acid-base balance and removing small-molecular-weight toxins in patients with end-stage renal disease.Additionally,residual kidney function also has the ability to remove middle-molecular-weight and protein-binding toxins.Endogenous clearance conferred by residual kidney function is significantly associated with survival.Hemodialysis adequacy of the patients with considerable residual kidney function should be evaluated by stdKt/Vurea.Currently,incremental hemodialysis has been attracted more attention because of its benefit of protecting residual kidney function.With incremental hemodialysis the hemodialysis dose is adjusted according to the level of residual kidney function.It has been reported that incremental hemodialysis can improve the quality of life and anemia management,reduce serumβ2-microglobulin,alleviate economic burden,and even increase survival rate.However,more evidences are required to support this strategy.