PDF(Pubmed)
Abstract：
UNASSIGNED: Longitudinal changes in residual kidney function have not been well-examined in patients starting chronic hemodialysis (HD).
UNASSIGNED: We analyzed urine volume and kidney solute clearances from timed urine collections and corresponding plasma samples from 42 patients randomized to incremental HD (n = 21) and conventional HD (n = 21) in the TwoPlus pilot study. Samples were collected before HD initiation (baseline); and at 6, 12, 24, and 48 weeks. We assessed temporal trends in urine volume, kidney urea and creatinine clearance, and correlations between urine volume and kidney solute clearance.
UNASSIGNED: Residual kidney function parameters in all patients declined over time; the pattern of decline differed between urine volume and kidney solute clearances. Urine volume declined at a steady rate with median (quartile 1, quartile 3) percentage change relative to baseline of -10% (-36 to 29) at week 6 and -47% (-76 to 5) by week 48. Kidney urea and creatinine clearances exhibited a larger decline than urine volume at week 6, -32% (-61 to 8) and -47% (-57 to -20), respectively. The rate of decline subsequently slowed, reaching about 61% decline for both solutes by week 48. Conventional HD demonstrated larger declines in urine volume and kidney urea clearance than incremental HD at week 6. Urine volume showed moderate correlation with urea (R = 0.47) and weaker correlation with creatinine (R = 0.34).
UNASSIGNED: Despite gradual decrement in urine volume and kidney solute clearances, residual kidney function persists nearly 1 year after HD initiation. This knowledge could motivate increased practice of individualizing HD prescriptions by incorporating residual kidney function.
UNASSIGNED: We analyzed urine volume and kidney solute clearances from timed urine collections and corresponding plasma samples from 42 patients randomized to incremental HD (n = 21) and conventional HD (n = 21) in the TwoPlus pilot study. Samples were collected before HD initiation (baseline); and at 6, 12, 24, and 48 weeks. We assessed temporal trends in urine volume, kidney urea and creatinine clearance, and correlations between urine volume and kidney solute clearance.
UNASSIGNED: Residual kidney function parameters in all patients declined over time; the pattern of decline differed between urine volume and kidney solute clearances. Urine volume declined at a steady rate with median (quartile 1, quartile 3) percentage change relative to baseline of -10% (-36 to 29) at week 6 and -47% (-76 to 5) by week 48. Kidney urea and creatinine clearances exhibited a larger decline than urine volume at week 6, -32% (-61 to 8) and -47% (-57 to -20), respectively. The rate of decline subsequently slowed, reaching about 61% decline for both solutes by week 48. Conventional HD demonstrated larger declines in urine volume and kidney urea clearance than incremental HD at week 6. Urine volume showed moderate correlation with urea (R = 0.47) and weaker correlation with creatinine (R = 0.34).
UNASSIGNED: Despite gradual decrement in urine volume and kidney solute clearances, residual kidney function persists nearly 1 year after HD initiation. This knowledge could motivate increased practice of individualizing HD prescriptions by incorporating residual kidney function.
摘要：
■在开始慢性血液透析（HD）的患者中，残余肾功能的纵向变化尚未得到充分检查。
我们在TwoPlus初步研究中分析了42例随机接受增量HD（n=21）和常规HD（n=21）的患者的定时尿液收集和相应血浆样本的尿量和肾溶质清除率。在HD开始前(基线)和在第6、12、24和48周收集样品。我们评估了尿量的时间趋势，肾尿素和肌酐清除率，以及尿量与肾脏溶质清除率之间的相关性。
■所有患者的残余肾功能参数随时间下降；尿量和肾溶质清除率之间的下降模式不同。尿量以稳定的速率下降,在第6周时相对于基线的中位数(四分位数1,四分位数3)百分比变化为-10%(-36至29),到第48周时为-47%(-76至5)。在第6周时，肾脏尿素和肌酐清除率比尿量下降更大，分别为-32％（-61至8）和-47％（-57至-20），分别。随后下降速度放缓，到第48周，两种溶质的下降幅度约为61%。在第6周，常规HD显示出尿量和肾脏尿素清除率的下降幅度大于增量HD。尿量与尿素呈中等相关性(R=0.47),与肌酐呈较弱相关性(R=0.34)。
■尽管尿量和肾脏溶质清除率逐渐减少，残余肾功能在HD开始后持续近1年。这些知识可以通过结合残留的肾功能来激发个性化HD处方的更多实践。
我们在TwoPlus初步研究中分析了42例随机接受增量HD（n=21）和常规HD（n=21）的患者的定时尿液收集和相应血浆样本的尿量和肾溶质清除率。在HD开始前(基线)和在第6、12、24和48周收集样品。我们评估了尿量的时间趋势，肾尿素和肌酐清除率，以及尿量与肾脏溶质清除率之间的相关性。
■所有患者的残余肾功能参数随时间下降；尿量和肾溶质清除率之间的下降模式不同。尿量以稳定的速率下降,在第6周时相对于基线的中位数(四分位数1,四分位数3)百分比变化为-10%(-36至29),到第48周时为-47%(-76至5)。在第6周时，肾脏尿素和肌酐清除率比尿量下降更大，分别为-32％（-61至8）和-47％（-57至-20），分别。随后下降速度放缓，到第48周，两种溶质的下降幅度约为61%。在第6周，常规HD显示出尿量和肾脏尿素清除率的下降幅度大于增量HD。尿量与尿素呈中等相关性(R=0.47),与肌酐呈较弱相关性(R=0.34)。
■尽管尿量和肾脏溶质清除率逐渐减少，残余肾功能在HD开始后持续近1年。这些知识可以通过结合残留的肾功能来激发个性化HD处方的更多实践。
