透析模式对终末期肾病患者心血管结局影响的研究进展

Effect of dialysis mode on cardiovascular outcomes in patients with end stage renal disease

血液透析(HD)和腹膜透析(PD)是终末期肾脏病(ESRD)患者肾脏不完全替代治疗的两种模式,其患者的生存率大致相当。残余肾功能(RRF)的快速丧失、血流动力学不稳定导致的心肌和脑缺血、间歇性HD而不是毒素的持续清除等是导致HD患者心血管疾病死亡的危险因素。PD液中葡萄糖降解产物(GDPs)和糖基化终产物(AGEs)过度吸收引起的代谢问题、液体超载和常见的低钾血症是导致PD患者心血管疾病死亡的主要因素。该文结合相关文献,就两种透析模式对ESRD患者心血管疾病不良结局的影响进行了综述。

Hematodialysis(HD)and peritoneal dialysis(PD)are two modes of incomplete kidney replacement therapy for the patients with end-stage renal disease(ESRD),and the survival rate of the patients is roughly equivalent.The rapid loss of residual renal function(RRF),myocardial and cerebral ischemia caused by blood flow dynamic instability,and intermittent HD instead of continuous removal of toxins are the risk factors that contribute to cardiovascular disease death in the patients undergoing HD.The metabolic problems caused by excessive absorption of glucose degradation products(GDPs)and glycation end products(AGEs)in PD fluid,fluid overload and common hypokalemia are the main factors leading to cardiovascular disease death in PD patients.This paper reveiws the effects of two dialysis modes on the adverse cardiovascular disease outcomes in the patients with ESRD by combining with the related literature.