Abstract：
Avoiding excessive dialysis-associated volume depletion may help preserve residual kidney function (RKF). To establish whether knowledge of the estimated normally hydrated weight from bioimpedance measurements (BI-NHW) when setting the post-hemodialysis target weight (TW) might mitigate rate of loss of RKF, we undertook an open label, randomized controlled trial in incident patients receiving HD, with clinicians and patients blinded to bioimpedance readings in controls. A total of 439 patients with over 500 ml urine/day or residual GFR exceeding 3 ml/min/1.73m2 were recruited from 34 United Kingdom centers and randomized 1:1, stratified by center. Fluid assessments were made for up to 24 months using a standardized proforma in both groups, supplemented by availability of BI-NHW in the intervention group. Primary outcome was time to anuria, analyzed using competing-risk survival models adjusted for baseline characteristics, by intention to treat. Secondary outcomes included rate of RKF decline (mean urea and creatinine clearance), blood pressure and patient-reported outcomes. There were no group differences in cause-specific hazard rates of anuria (0.751; 95% confidence interval (0.459, 1.229)) or sub-distribution hazard rates (0.742 (0.453, 1.215)). RKF decline was markedly slower than anticipated, pooled linear rates in year 1: -0.178 (-0.196, -0.159)), year 2: -0.061 (-0.086, -0.036)) ml/min/1.73m2/month. Blood pressure and patient-reported outcomes did not differ by group. The mean difference agreement between TW and BI-NHW was similar for both groups, Bioimpedance: -0.04 kg; Control: -0.25 kg. Thus, use of a standardized clinical protocol for fluid assessment when setting TW is associated with excellent preservation of RKF. Hence, bioimpedance measurements are not necessary to achieve this.
摘要：
避免过度透析相关的容量消耗可能有助于保留残余肾功能(RKF)。确定在设定血液透析后目标体重（TW）时，从生物阻抗测量（BI-NHW）中估计的正常水合体重是否可以减轻RKF的损失率，我们进行了一个开放的标签，在接受HD的事件患者中进行的随机对照试验，临床医生和患者对对照组的生物阻抗读数视而不见。从34个英国中心招募了439例尿液/天超过500ml/min/1.73m2或残留GFR超过3ml/min/1.73m2的患者，并以1：1的比例随机分组，按中心分层。两组均使用标准化形式进行了长达24个月的液体评估，在干预组中补充BI-NHW。主要结果是无尿时间，使用针对基线特征进行调整的竞争风险生存模型进行分析，打算治疗。次要结局包括RKF下降率（平均尿素和肌酐清除率），血压和患者报告的结果。无尿的原因特异性危险率（0.751;95％置信区间（0.459，1.229））或次分布危险率（0.742（0.453，1.215））没有组间差异。RKF的下降速度明显慢于预期，第1年的合并线性汇率：-0.178（-0.196，-0.159）），年2:-0.061(-0.086,-0.036))ml/min/1.73m2/月。各组血压和患者报告的结果没有差异。两组TW和BI-NHW之间的平均差异一致性相似，生物阻抗:-0.04kg;对照:-0.25kg。因此，当设置TW时，使用标准化的临床方案进行液体评估与RKF的出色保存相关。因此，生物阻抗测量是没有必要实现这一点。
