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Qhov tseem ceeb ntawm Residual raum Function hauv Hemodialysis Cov Neeg Mob

Mar 19, 2022

Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com

JESSICA KONG, et al

TSEEM CEEB:Nyob rau hauv sib piv rau peritoneal dialysis,residual raum ua haujlwm(RKF) feem ntau tsis pom zoo rau cov neeg mob hemodialysis (HD) thiab tsis raug saib xyuas los yog coj mus rau hauv tus account hauv kev kho mob niaj hnub. Qhov no txawm hais tias muaj pov thawj tias qib siab ntawm RKF hauv HD cov neeg mob cuam tshuam nrog cov txiaj ntsig zoo dua, suav nrog kev muaj sia nyob, tag nrho cov kua dej tshem tawm, khoom noj khoom haus, o, thiab kua dej sib npaug. Qhov kev tshuaj xyuas no yog txhawm rau txheeb xyuas cov txiaj ntsig kho mob ntawm RKF tshwj xeeb hauv cov neeg mob HD. Qee theem ntawm RKF(residual raum ua haujlwm)tam sim no nyob rau hauv ntau dua 80 feem pua ​​​​ntawm cov neeg mob thaum lub sijhawm pib lim ntshav, thiab thaum qhov no poob qis rau lub sijhawm, txog li 30 feem pua ​​​​ntawm cov neeg mob HD rau 5 xyoo tseem muaj qhov ntsuas tau ntawm lub raum ua haujlwm. Muaj pov thawj me me ntawm yuav ua li cas zoo tshaj plaws los khaws RKF hauv HD cov neeg mob, txawm hais tias nws tau pom tias cov kev tswj hwm HD hnyav hauv qhov xwm txheej HD cov neeg mob tshwm sim ua kom RKF poob qis. RKF(residual raum ua haujlwm)tsis yog feem ntau suav nrog hauv HD tshuaj thiab kev ntsuas ntawm qhov txaus, txawm hais tias qee cov lus qhia xws li Kab Mob Raum Cov Kab Mob Zoo Tshaj Plaws (KDOQI) thiab European Cov Txheej Txheem Zoo Tshaj Plaws qhia tias nws tsim nyog ua li ntawd. Qhov no yuav muaj feem cuam tshuam, yam tsawg kawg hauv ib feem, rau kev nkag siab txog qhov tsis yooj yim ntawm kev sau cov zis nyob rau lub sijhawm thiab rau qhov nyuaj thiab tsis muaj kev pom zoo txog cov txheej txheem rau kev sib koom ua ke ntawm kev sib tshuam ntawm HD nrog kev tshem tawm tas li ntawm cov neeg lub raum.muaj nuj nqi. Kev tshawb fawb ntxiv yog yuav tsum tau ua kom zoo tshaj plaws los tswj thiab ua kom muaj txiaj ntsig zoo ntawm RKF hauv HD cov neeg mob.

KEYWORDS- lub raum tsis ua haujlwm kawg, hemodialysis, incremental hemodialysis,residual raum ua haujlwm.

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Cistanche tuaj yeem txhim kholub raum ua haujlwm

Residual raum ua haujlwm(RKF) hauv cov neeg mob ntshav lim ntshav tau txhais los ntawm qhov muaj peev xwm ntawm cov kab mob hauv lub raum kom tso dej thiab uraemic solutes. Nyob rau hauv sib piv rau peritonealdialysis (PD), nyob rau hauv hemodialysis (HD) xyaum, RKF(residual raum ua haujlwm)feem ntau tsis yog ntsuas los yog coj mus rau hauv tus account thaum txiav txim siab kho mob lossis tshuaj lim ntshav. Qhov no yog txawm hais tias muaj RKF siab dua sib txuas nrog cov txiaj ntsig zoo dua, xws li kev txhim kho kev ciaj sia, kev tshem tawm cov kuab tshuaj, khoom noj khoom haus, 1 anemia, thiab phosphate tswj,2cov lus qhia tias kev siv zog rau kev saib xyuas thiab khaws cia RKF hauv HD cov neeg mob yuav tsim nyog (Table 1). Ob lub raum Kab Mob Qhov Ua Tau Zoo Tshaj Plaws (KDOQI)3 thiab European Txoj Cai Ua Haujlwm Zoo Tshaj Plaws (EBPG)4 tau tawm tswv yim tias RKF tuaj yeem muab tso rau hauv HD tshuaj, thiaj li hu ua incremental HD, tab sis qhov no tsis tau siv dav vim qhov tsis paub tseeb txog qhov no tuaj yeem ua tau zoo. thiab nyab xeeb ua tiav.

table 1

Lub hom phiaj tseem ceeb ntawm kev tshuaj xyuas no yog los sau cov ntaub ntawv tam sim no txog kev sib raug zoo ntawm RKF(residual raum ua haujlwm)thiab cov txiaj ntsig tshwj xeeb hauv cov pej xeem HD. Tsis tas li ntawd, peb tsom los tham txog cov txheej txheem rau RKF ntsuas thiab luv luv tham txog yuav ua li cas RKF(residual raum ua haujlwm)tej zaum yuav raug coj mus rau hauv tus account hauv kev txiav txim siab ntawm HD dosing.

Txoj kev

Cov ntaub ntawv tau txais los ntawm kev tshawb nrhiav Ovid MEDLINE thiab EMBASE cov ntaub ntawv nruab nrab ntawm 15 Lub Yim Hli 2017 thiab 01 Lub Peb Hlis 2018. Cov lus tshawb fawb siv yog 'mob raum tsis ua haujlwm', 'hemodialysis', 'residuallub raum ua haujlwm', 'residualkidney muaj nuj nqi', thiab 'incremental'. Tag nrho ntawm 650 kab lus tau txais. Cov ntawv uas tsis yog lus Askiv, duplicates, thiab cov ntawv uas tsis muaj kev paub daws teeb meem tau raug cais tawm. Cov ntawv txuas ntxiv tau manually tau los ntawm cov npe siv ntawm cov khoom muaj feem cuam tshuam. Cov ntawv tau suav nrog yog tias lawv lub hom phiaj tseem ceeb yog RKF(residual raum ua haujlwm)nyob rau hauv HD neeg mob cov pej xeem thiab incremental HD.

RKF(residual raum ua haujlwm)THIAB PATIENT SURVIVAL

Qhov tseem ceeb ntawm RKF(residual raum ua haujlwm)tau pom nyob rau hauv ntau txoj kev tshawb fawb ntawm PD, tab sis cov pov thawj cuam tshuam txog nws cov txiaj ntsig hauv HD tau tshwm sim tsis ntev los no. Hais txog PD cov ntaub ntawv, kev tshawb xyuas rov qab los ntawm Canada-United States Peritoneal Dialysis (CANUSA) txoj kev tshawb fawb pom tau tias muaj txiaj ntsig zoo ntawm RKF(residual raum ua haujlwm)nyob rau hauv 601 cov neeg mob raum kab mob kawg uas tau koom nrog hauv ntau qhov chaw, kev tshawb fawb yav tom ntej.5Muaj 12 feem pua ​​​​txo qis hauv cov txheeb ze kev pheej hmoo (RR) ntawm kev tuag nrog txhua 5 L / lub lis piam ib 1.73 m2 nce hauv glomerular filtrationrate (GFR) thiab 36 feem pua ​​​​ntawm RR ntawm kev tuag nrog txhua 250 mL nce hauv cov zis ntim. Hauv qhov sib piv, peritonealclearance tsis tau pom tias cuam tshuam nrog cov neeg mob muaj sia nyob.

Ntau qhov kev tshawb fawb tau sim tshuaj xyuas yog tias lub koom haum no tuaj yeem txuas mus rau cov neeg mob HD. Hauv Netherlands CooperativeStudy ntawm Kev Txaus Siab ntawm Dialysis (NECOSAD) txoj kev tshawb fawb, 740 qhov xwm txheej HD cov neeg mob tau ua raws li lub sijhawm nruab nrab ntawm 1.7 xyoo, thiab cov neeg mob muaj sia nyob ntawm RKF(residual raum ua haujlwm)tau tshawb xyuas.6Kev tuag yog 56 feem pua ​​​​qis nrog txhua 1.0 chav tsev nce hauv lub raum urea tus qauv Kt/V/lub lim tiam(RR 0.44; 95 feem pua ​​​​CI, 0.30 -{10}}.65, P < 0.0001).

Cov Kev Xaiv rau Kev Noj Qab Haus Huv Cov txiaj ntsig hauv Kev Saib Xyuas Kab Mob Thaum Ntxov (CHOICE) txoj kev tshawb fawb tau ua raws li 734 tus neeg mob HD rau ib xyoos thiab pom cov txiaj ntsig zoo sib xws. Hauv qhov kev tshawb fawb no, RKF tau txhais tias tus neeg mob tau tshaj tawm cov zis tso zis (UO) tsawg kawg yog 250 mL txhua hnub. Kev ruaj ntseg RKF(residual raum ua haujlwm)nyob rau hauv 1 xyoo yog nyob rau hauv kev sib raug zoo nrog 30 feem pua ​​​​txo tag nrho-ua rau kev tuag (HR 0.7, CI 0.52–0.93, P=0.02), txawm tom qab hloov kho rau confounders nrog rau cov pej xeem thiab cov yam ntxwv kho mob.7

Tsis tas li ntawd, txoj kev tshawb nrhiav kev soj ntsuam yav tom ntej los ntawm Shemin li al. pom tias muaj RKF(residual raum ua haujlwm), txawm nyob rau theem qis, tau txais txiaj ntsig. Hauv txoj kev tshawb no, tom qab kev hloov kho rau lwm yam, RKF tau tiv thaiv kev tuag ntau dua li ntawm {{{0}}ib xyoos (qhov sib txawv (OR) 0.44; 95 feem pua ​​​​CI 0.24 -0.81,P=0.008).8Cov txheej txheem los ntawm qhov kev pheej hmoo ntawm RKF tuaj yeem ua rau muaj kev vam meej zoo tuaj yeem ua rau muaj ntau yam thiab tau piav qhia hauv qab no thiab hauv Table 1.

Cistanche can improve kidney function

Cistanche tuaj yeem txhim kholub raum ua haujlwm

TSEEM CEEB RKF(residual raum ua haujlwm)RAU SOLUTE CLEARANCE

Nyob rau hauv sib piv rau lub intermittent clearance ntawm solutes muab los ntawm HD, haiv neeglub raum ua haujlwmyog tas mus li, thiab qhov no yuav piav qhia txog cov txiaj ntsig tau muab los ntawm RKF hauv cov neeg mob lub raum kawg. Kt/Vurea, dialyzer urea clearance adjusted for volume of distribution, feem ntau yog siv los ua tus cim ntawm kev lim ntshav txaus. Ib txwm nyob hauv lub raum urea tshem tawm (KRU) ntawm 3 mL / min hauv tus neeg mob nruab nrab yog sib npaug rau Kt / Vurea txhua lub lim tiam ntawm kwv yees li 1.0.3

Fry et al. npaj siab tias cov txiaj ntsig cuam tshuam nrog RKF(residual raum ua haujlwm)Tsis tsuas yog vim kev txhim kho kev tshem tawm ntawm cov khoom hnyav me me, xws li urea thiab creatinine, tab sis kuj yog vim muaj cov co toxins loj dua, xws li nruab nrab molecular hnyav molecules, uas tsis zoo tshem tawm los ntawm HD.9Hauv ntu ntu, rov qab, soj ntsuam kev tshawb fawb nrog 297 tus neeg mob, beta-2 microglobulin (2M) tau siv los ua tus sawv cev nruab nrab ntawm cov molecule. Txoj kev tshawb no pom tias RKF koom nrog kev tshem tawm zoo dua ntawm 2M. Cov neeg mob uas muaj KRU < 0.5="" ml/min="" muaj="" ntau="" dua="" 2m="" qib="" dua="" li="" cov="" kru="" ntawm="" 0.5–1="" ml/min="" (28.2="" ntxiv="" rau="" -6.2="" vs23.1="" ntxiv="" rau="" {{="" 17}}.6="" mg/l,="" p="">< 0.001),="" qhia="" tias="" txawm="" tias="" qib="" qis="" ntawm="" rkf="" tej="" zaum="" yuav="" muaj="" txiaj="" ntsig.="" cov="" txiaj="" ntsig="" zoo="" sib="" xws="" tau="" tshaj="" tawm="" hauv="" lwm="" txoj="" kev="" tshawb="" fawb="" uas="" cov="" neeg="" mob="" nrog="" rkf="" tau="" pom="" tias="" muaj="" qib="" qis="" ntawm="">10

RKF(residual raum ua haujlwm)THIAB FLUID BALANCE Cov kab mob plawv tau paub tias yog ib qho ua rau kev tuag ntawm cov neeg mob HD. Cov kev txiav txim tseem ceeb suav nrog ceev atherosclerosis thiab sab laug ventricular hypertrophy (LVH). Ob qho tib si ntim ntau dhau thiab nce ntawm tag nrho cov kab mob peripheral vascular tsis kam hauv HD cov neeg mob ua rau LVH. Lub xub ntiag ntawm RKF(residual raum ua haujlwm)tuaj yeem txhim kho cov kua dej sib npaug thiab yog li muab cov txiaj ntsig ntawm lub plawv.

Cov kev tshawb fawb hla dhau los ua hauv PD cov neeg mob tau pom tias qhov poob qis hauv RKF(residual raum ua haujlwm)nws tus kheej cuam tshuam nrog nce sab laug ventricular mass index11nrog rau kev tswj ntshav siab tsis zoo.12Hauv HD cov neeg mob, RKF(residual raum ua haujlwm)pab txhawb kev txhim kho lub peev xwm rau kev tshem tawm sodium thiab ntim tswj, qhia los ntawm kev txo qis hauv nruab nrab-dialytic hnyav nce.13Ib qho kev xav tau qis dua ultrafiltration kuj tau sau tseg hauv cov neeg mob nrog KRU Ntau dua lossis sib npaug li 1 mL / min ib 1.73 m2.14Ib qho kev soj ntsuam kev soj ntsuam ntawm 59 tus neeg mob HD kev saib xyuas tau soj ntsuam cov kev mob plawv ntawm RKF, txhais tau tias muaj 24-h UO > 200 mL.15Txoj kev tshawb no pom tias LVH thiab sab laug ventricular systolic dysfunction tsis tshua muaj hnyav rau cov neeg mob RKF piv nrog cov tsis muaj RKF, xav tias muaj feem cuam tshuam rau cov kua dej zoo dua thiab kev tswj ntshav siab los ntawm RKF.

Qhov no sib piv nrog cov txiaj ntsig los ntawm kev tshawb fawb yav tom ntej, uas qhia tias qhov kev pheej hmoo ntawm RKF(residual raum ua haujlwm)feem ntau nyob ntawm qhov ntim ntau dhau.16 Cov xwm txheej ntim tau raug soj ntsuam los ntawm kev ntsuas plawv thiab sab laug ventricular chamber loj ntawm kev kuaj echocardiographic. Kev tswj lub ntim nruj tau siv rau 19 qhov xwm txheej HD cov neeg mob rau 3 lub hlis. Nws tau pom tias sab laug ventricular huab hwm coj qis qis los ntawm 36 feem pua ​​​​ntawm lub sijhawm no, qhia txog kev rov qab los ntawm LVH, thaum muaj qhov txo qis hauv RKF kuj tau sau tseg, qhia tias kev khaws cia ntawm RKF tuaj yeem ua rau ntim ntau dhau thiab LVH. Lub zog ntawm txoj kev tshawb no, txawm li cas los xij, txwv los ntawm nws cov qauv me me thiab lub sijhawm kawm luv luv. Txawm li cas los xij, qhov kev tshawb fawb no qhia tau hais tias mob hypervolemia raws li ib txoj hauv kev khaws cia RKF yuav tsum zam. Ntawm qhov ceeb thawj, kev tshawb fawb hauv cov neeg mob PD tau pom tias qhov nthuav dav ntxiv ntawm lub cell tsis pab khaws cia RKF,17,18whereas ntim depletion tuaj yeem, raws li qhov xav tau, cuam tshuam tsis zoo rau RKF.19

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Cistanche tuaj yeem txhim kholub raum ua haujlwm

RKF(residual raum ua haujlwm)THIAB INFLAMMATION

Kev mob ntev, qib qis yog tshwm sim hauv cov neeg mob chronicdialysis, txawm hais tias qhov tseeb ntawm cov txheej txheem tsis nkag siab tag nrho. Ib feem ntawm qhov nce inflammatory teb tej zaum yuav muaj feem xyuam rau platelet contact activation thiab ntxiv cascade activation los ntawm cov ntshav ntws los ntawm extracorporeal circuit, uas ua rau kev tso tawm ntawm ntau yam pro-inflammatory cytokines.A cross-sectional observational study by de Sequera li al.found tias ntau dua. RKF(residual raum ua haujlwm)was associated with lower levels of inflammatory parameters.10 A lower percentage of CD14 +/CD16++ inflammatory monocytes (14.6% vs 28.3%, P = 0.02) and lower concentrations of C-reactive protein (CRP) (6.2 vs 21.4 mg/L, P = 0.038) were found in patients with KRU >1 mL/min and diuresis >100 ml / hnub. ActivatedCD16 ntxiv rau monocytes induce endothelial kev puas tsuaj, uas yuav ua rau kev loj hlob ntawm atherosclerosis. Shafi et al. kuj tau soj ntsuam ib qho kev koom tes zoo sib xws ntawm RKF thiab qis qis ntawm cov cim inflammatory CRP thiab interleukin (IL)-6.7 Ib yam li ntawd, Yang li al. pom ntau dua UO hauv HD cov neeg mob cuam tshuam nrog qis qis ntawm CRP siab.20

RKF(residual raum ua haujlwm)THIAB NUTRITIONAL STATUS

Hauv kev tshawb nrhiav rov qab ntawm 650 qhov xwm txheej HD cov neeg mob, RKF(residual raum ua haujlwm)tau pom tias muaj feem cuam tshuam nrog kev noj zaub mov zoo dua.14Piv nrog rau cov neeg mob nrog KRU<1 ml/min="" per="" 1.73="" m2,="" those="" with="" kru="" ≥="" 1="" ml/min="" per="" 1.73="" m2="" had="" higher="" serum="" albumin="" and="" normalized="" protein="" catabolic="" rate="" (npcr)="" for="" up="" to="" 36="" months.="" a="" cross-sectional="" multicentre="" study="" conducted="" in="" taipei="" with="" 704="" maintenance="" hd="" patients="" also="" found="" results="" that="" suggest="" rkf="">(residual raum ua haujlwm)pab txhawb kev noj zaub mov zoo hauv cov neeg mob HD, nrog rau 1-litre nce ntxiv hauv cov seem 24-h cov zis ntim txuam nrog 1.4 g / Lincrease hauv cov ntshav albumin.20

RKF thiab RENAL ANEMIA

Cov kev tshawb fawb soj ntsuam tau pom qhov yuav tsum tau ua rau txo qis erythropoietin (EPO)-tus neeg sawv cev rau cov neeg mob uas muaj RKF tseem ceeb.(residual raum ua haujlwm). Vilar et al. pom qhov txo qis EPO koob tshuaj txhua lub lim tiam thiab txo EPO qhov ntsuas qhov tsis kam mus txog 48 lub hlis tom qab HD pib hauv cov neeg mob nrog KRU Ntau dua lossis sib npaug li 1 mL / min ib 1.73 m2, txawm hais tias tsis muaj qhov sib txawv tseem ceeb hauv cov ntshav hemoglobin tau sau tseg.14

Txoj kev tshawb fawb CHOICE kuj tau qhia tias cov neeg mob uas niaj hnub UO > 250 mL ntawm 1 xyoo tom qab pib HD yuav tsum tau qis dua ntawm EPO piv nrog cov uas tsis muaj (P=0.001).7 Cov qauv zoo sib xws tau sau tseg nrog EPO tsis kam index. .

RKF thiab PHOSPHATE BALANCE

Hyperphosphatemia yog txuam nrog vascular calcification thiab plawv plawv tuag ntawm cov neeg mob dialysis. Iwasawa et al. tshawb xyuas yog RKF(residual raum ua haujlwm)pab txhawb kev tshem tawm cov tshuaj tophosphate, ua ib qho kev rov qab los, kev tshawb nrhiav ntu ntu nrog 79 tus neeg mob HD ntev tau muab faib ua ob pawg: 35 cov neeg mob uas muaj GFR Ntau dua lossis sib npaug rau 3 mL / minand 44 cov neeg mob nrog GFR.<3 ml/min.21="" phosphate="" removed="" by="" dialysis="" was="" assessed="" in="" nine="" anuric="" patients.="" a="" linear="" association="" was="" observed="" between="" residual="" gfr="" and="" urinary="" phosphate="" excretion.="" patients="" with="" gfr="" ≥="" 3="" ml/min="" had="" approximately="" double="" mean="" weekly="" phosphate="" removal="" (2000.3+-804.1="" mg)="" compared="" with="" the="" amount="" of="" phosphate="" removed="" in="" a="" single="" hd="" session="" (1019.9+-300="" mg)="" (p="" <="" 0.001).="" in="" contrast,="" patients="" with="" gfr="" <="" 3="" ml/min="" (952.9="" +-="" 418.8="" mg)="" had="" similar="" mean="" weekly="" phosphate="" removal="" compared="" with="" that="" removed="" by="" a="" single="" hd="">

Lwm qhov kev tshawb fawb hla ntu tau ua hauv Suav teb pom cov txiaj ntsig zoo sib xws.22 RKF(residual raum ua haujlwm)tau pom tias muaj feem cuam tshuam nrog lub peev xwm tseem ceeb rau kev tso tawm phosphate. Txhua lub lis piam phosphate excretion los ntawm cov zis nyob rau hauv cov neeg mob nrog RKF (txhua hnub UO > 200 mL) tau pom los ntawm 300 txog 1500 mg, uas yog sib npaug rau tag nrho cov kev tshem tawm los ntawm ib zaug 4-h HD kev sib kho .Qhov no kuj tseem muaj txiaj ntsig ntau dua li cov neeg mob uas niaj hnub UO tsawg dua lossis sib npaug li 200 mL (769 ntxiv rau -318 vs 122 ntxiv rau -106 mg/lub lim tiam, P < 0.001).qhov="" no="" suav="" nrog="" cov="" kev="" cai="" qis="" dua="" rau="" kev="" sib="" khi="" phosphate="" tshuaj="" (caco3)="" hauv="" cov="" neeg="" mob="" no.="" interestingly,="" anuric="" cov="" neeg="" mob="" uas="" muaj="" ntau="" dua="" predialysis="" serum="" phosphate="" concentration="" tau="" qis="" phosphate="" tshem="" tawm="" los="" ntawm="" ib="" tug="" hd="" session="" piv="" nrog="" cov="" neeg="" uas="" muaj="" rkf.="" cov="" txheej="" txheem="" hauv="" qab="" thiab="" cov="" kinetics="" ntawm="" phosphate="" thaum="" hd,="" txawm="" li="" cas="" los="" xij,="" tseem="" tsis="" tau="" nkag="" siab.="" txoj="" kev="" tshawb="" no="" tseem="" txwv="" los="" ntawm="" kev="" tsis="" muaj="" peev="" xwm="" sau="" tau="" cov="" neeg="" mob="" cov="" khoom="" noj="" phosphate="" intakeas="" thiab="" nws="" cov="" qauv="" me="">

RKF THIAB VASCULAR DISEASE

Kab mob vascular yog lwm qhov teeb meem uas ua rau muaj kev mob plawv tseem ceeb hauv cov neeg mob HD, tab sis ob peb txoj kev tshawb fawb tau tshuaj xyuas kev sib raug zoo ntawm RKF.(residual raum ua haujlwm)thiab vascular calcification thiab atherosclerosis.Feem ntau tsis ntev los no, ib qho kev soj ntsuam kev soj ntsuam hla ntu tau teeb tsa los tshuaj xyuas kev sib raug zoo ntawm RKF thiab atherosclerosis.23 in a study of 39 PD patients and 53 HD patients who were on maintenance dialysis therapy for at least 3 months to up to 3 years. In this study, atherosclerosis was defined as >10 hli carotid artery intima media thickness thiab/los yog muaj cov quav hniav kuaj pom los ntawm B-mode ultrasound.RKF tau ntsuas raws li GFR muab los ntawm inter-dialytic urinecollection. Nyob rau hauv ob qho tib si univariate thiab multivariate tsom xam, siab dua RKF(residual raum ua haujlwm)kwv yees qhov kev pheej hmoo tsawg dua ntawm atherosclerosis(LOSSIS {{{0}}}.95; 95 feem pua ​​CI 0.54–0.99, P=0.041). Txawm li cas los xij, qhov kev tshuaj ntsuam no tsis yog tshwj xeeb rau cov neeg mob HD.

Lwm qhov kev tshawb fawb hla ntu ua hauv Suav teb tau tshaj tawm txog kev sib koom ua ke ntawm kev poob ntawm RKF(residual raum ua haujlwm)thiab abdominalaortic calcification (ACC).24Nyob rau hauv txoj kev tshawb no, kev poob ntawm RKF tau raug txhais ua txhua hnub UO < 200="" ml,="" thiab="" lub="" plab="" acc="" tau="" ntsuas="" raws="" li="" cov="" duab="" hluav="" taws="" xob="" lumbar.="" kev="" poob="" ntawmrkf="" tau="" cuam="" tshuam="" nrog="" cov="" qhab="" nia="" siab="" dua,="" nrog="" abeta="" ntawm="" 0.22="" (95="" feem="" pua="" ​​​​ci="" 0.08–0.53,="" p="0.01)," raws="" li="" kev="" txheeb="" xyuas="" los="" ntawm="" ntau="" qhov="" sib="" txawv="" ntawm="" cov="" kab="" rov="" tav.="" lub="" koom="" haum="" no="" tsis="" muaj="" kev="" ywj="" pheej="" los="" ntawm="" kev="" txheeb="" xyuas="" cov="" teeb="" meem="" ntawm="" vascular="" calcifications="" xws="" li="" hnub="" nyoog,="" hd="" vintage,="" ntshav="" qab="" zib,="" crp,="" thiab="" calcium-phosphorus="">

RKF thiab QUALITY OF LIFE (QOL)

RKF(residual raum ua haujlwm)tau txuam nrog QoL zoo dua hauv cov neeg mob PD.25Cov txheej txheem tsis paub meej tab sis tuaj yeem cuam tshuam rau kev txhim kho khoom noj khoom haus, kua dej sib npaug, anemia, thiab phosphatecontrol. Hauv txoj kev tshawb fawb CHOICE, HD cov neeg mob nrog UO ntawm lub hauv paus kuj tau tshaj tawm tag nrho zoo dua QoL (P=0.05) raws li kev soj ntsuam los ntawm daim ntawv nug tus neeg mob tau lees paub tus kheej.7 Txawm li cas los xij, cov ntaub ntawv hais txog cov tsos mob tshwj xeeb hauv kev cuam tshuam rau RFK feem ntau tsis muaj nyob hauv HD cov neeg mob.

Cistanche can improve kidney function

Cistanche tuaj yeem txhim kholub raum ua haujlwm

RKF kev ntsuas

Muaj kev sib cav txog txoj hauv kev zoo tshaj plaws los ntsuas RKF(residual raum ua haujlwm). Lub raum ua haujlwmfeem ntau yog ntsuas raws li GFR. Txoj kev zoo tshaj plaws rau kev ntsuas RKF yog ib qho uas muaj tseeb, rov ua dua tshiab, siv tau zoo, thiab ua tau yooj yim. Tam sim no, tsis muaj ib qho ntawm cov kev xaiv uas muaj zoo kawg nkaus ua tiav cov qauv no, xws li kev xaiv ntawm cov txheej txheem muaj qee qhov kev cuam tshuam ntawm qhov tseeb, yooj yim, thiab tus nqi. Cov txheej txheem ncaj qha xws li inulin, 51chromium ethylenediaminetetraacetic acid (EDTA), thiab iothalamate radiocontrast clearance yog suav tias yog txoj hauv kev zoo tshaj plaws ntawm kev txiav txim siab GFR tab sis muaj qhov chaw txwv hauv kev saib xyuas niaj hnub ntawm RKF thiab tsis tau kawm txaus rau lub hom phiaj no.

Tam sim no, RKF feem ntau yog ntsuas los ntawm lub sijhawm sau rau urea thiab creatinine tshem tawm.3Qhov no yog qhov ua tau zoo tshaj plaws nyob rau tag nrho lub sijhawm dialytic, feem ntau 44 h rau kev tswj hwm peb lub lis piam, txhawm rau txo cov txiaj ntsig ntawm kev hloov pauv hauv GFR thoob plaws lub sijhawm dialytic. Lwm txoj hauv kev yog 24-h tso zis, uas tej zaum yuav yooj yim dua rau cov neeg mob. Ib qho teeb meem nyuaj thaum ntsuas RKF(residual raum ua haujlwm)los ntawm kev sau cov zis raws sij hawm hauv cov neeg mob HD, piv nrog cov neeg mob PD, yog qhov hloov pauv ntawm urea thiab creatinine theem thoob plaws lub sijhawm interdialytic. Txhawm rau daws qhov no, txoj kev pom zoo yog siv cov txiaj ntsig ntawm kev ntsuas ntshav ntshav thaum pib thiab xaus ntawm lub sijhawm sau zis.4

Lub raum urea clearance underestimates GFR vim tubularreabsorption, thaum creatinine clearance overestimates GFRdue rau tubular secretion. Qhov nruab nrab ntawm urea thiab creati cuaj clearances tau pom tias muaj kev sib raug zoo nrog inulinclearance.26Vim li no, EBPG cov lus qhia pom zoo ntsuas RKF(residual raum ua haujlwm)nyob rau hauv HD cov neeg mob raws li qhov seem GFR, txiav txim siab raws li lub ntsiab lus ntawm urea thiab creatinine clearances.4 Qhov kev tshem tawm no, txawm li cas los xij, tsis raug suav rau tubular muaj nuj nqi lossis tshem tawm cov protein-bound solutes thiab nruab nrab molecular hnyav molecules. Hauv qhov sib piv, KDOQI cov lus qhia qhia ntsuas RKF los ntawm urea clearance (KRU),3uas muaj qhov tsis zoo ntawm kev kwv yees GFR tab sis txo qhov kev pheej hmoo ntawm overestimating GFR thiab pab txhawb kev sib koom ua ke ntawm RKF nrog kev lim ntshav, uas los ntawm cov lus pom zoo raws li urea kinetics.

Cov kev tshawb fawb tsis ntev los no kuj tau xav txog lwm txoj hauv kev ntsuas RKF(residual raum ua haujlwm)Nyob rau tib lub sijhawm, suav nrog kev ntsuas cov ntshav biomarkers tshiab xws li cystatin C, beta 2 microglobulins (2M), thiab beta-trace protein. Lub ntsiab kom zoo dua ntawm txoj kev no yog kev zam ntawm qhov xav tau ntawm cov khoom siv sijhawm ntev. Wong et al. pom tau hais tias cov ntshav 2Mis nws tus kheej cuam tshuam nrog tsuas yog RKF thiab mob ntshav qab zib mellitus tab sis tsis yog nrog kev lim ntshav suav nrog Kt / V, thiab tuaj yeem siv los ua tus cim rau RKF.27 Hauv qhov kev tshawb fawb no, qhov sib npaug tau muab los ntawm cov ntshav 2M thiab beta trace protein los kwv yees GFR thiab KRU, thiab cov kev sib npaug no tom qab ntawd tau sim nyob rau hauv ib pawg validation, sib piv cov nqi suav nrog ntsuas KRU thiab GFR ( xam los ntawm qhov nruab nrab ntawm cov zis urea thiab creatinine clearances). Cov neeg mob uas KRU > 2 mL / min raug txheeb xyuas kom raug hauv 90 feem pua ​​​​ntawm cov neeg mob. Qhov kev kwv yees kwv yees rau GFR uas suav nrog ob qho tib si beta-trace protein thiab 2M muab qhov kwv yees zoo dua li ib leeg. Hypothetically, yog tias txoj kev no tau siv los txheeb xyuas cov neeg mob uas muaj RKF txaus los tso cai hloov kho HD koob tshuaj, ntau dua 95 feem pua ​​​​ntawm cov neeg mob yuav tau txais cov tshuaj lim ntshav ntawm lossis siab dua lub hom phiaj los ntawm KDOQI cov lus qhia, tab sis 5 feem pua ​​​​ntawm cov neeg mob yuav raug mob ntshav qab zib. Ib qho kev txwv ntawm kev tshawb fawb yog tias biomarkers kuj tsuas yog ntsuas ntawm ib lub sij hawm taw tes xwb, thiab yog li, qhov kev hloov pauv ntawm cov cim no txheeb ze rau qhov kev nce zuj zus ntawm RKF tsis tau kawm. Tsis tas li ntawd, 2M qib kuj tseem tuaj yeem cuam tshuam los ntawm kev sib kis thiab lwm yam kev kho mob uas tsis to taub tag nrho. Kev kwv yees ntawm RKF siv cov ntshav plasma beta-traceprotein kuj tseem tsis tshua muaj tseeb hauv cov neeg mob uas tau txais kev kho mob haemodiafiltration, uas tau tshaj tawm tias yuav txo qis beta trace protein ntau li 61 feem pua.28

Trend thiab prevalence ntawm RKF

RKF(residual raum ua haujlwm)tau tshaj tawm tias yuav tswj tau zoo hauv cov neeg mob PD dua li cov neeg mob HD.19Jansen et al. pom tias, tom qab kev hloov kho rau cov kev hloov pauv hauv lub hauv paus thiab kev tso tawm, cov neeg mob PD tau pom tias muaj 30 feem pua ​​GFR siab dua li cov neeg mob HD (P <0.0001) ntawm="" 1="" xyoo="" tom="" qab="" pib="" kho.="" qhov="" kev="" tshaj="" tawm="" tshaj="" plaws="" ntawm="" kev="" poob="" qis="" hauv="" gfr="" tshwm="" sim="" hauv="" thawj="" 3="" lub="" hlis="" tom="" qab="" pib="" kho.="" txawm="" li="" cas="" los="" xij,="" mckane="" et="" al.="" pom="" tsis="" muaj="" qhov="" sib="" txawv="" ntawm="" qhov="" poob="" ntawm="" kru="" ntawm="" cov="" neeg="" mob="" uas="" tau="" txais="" high-flux="" biocompatible="" hd="" thiab="" cov="" neeg="" tau="" txais="" kev="" thauj="" mus="" los="" txuas="" ntxiv="">29Kev poob qis dua ntawm KRU tau pom nyob rau thawj 12 lub hlis tom qab pib lim ntshav. Whilst RKF poob qis tom qab pib lim ntshav, nws tau khaws cia hauv qee tus neeg mob. Kev tshawb fawb UK ntawm 650 qhov xwm txheej HD cov neeg mob pom tias 58.1 feem pua ​​​​thiab 31 feem pua ​​​​ntawm cov neeg mob muaj KRU Ntau dua lossis sib npaug li 1 mL / min ib 1.73 m2 ntawm 2 thiab 5 xyoo tom qab HD pib, feem.14 Me ntsis paub txog qhov xwm txheej thiab RKF muaj nyob rau hauv feem ntau HD pej xeem, nrog rau cov npe xws li ANZDATA tsis sau cov ntaub ntawv ntawm qhov no.

Cov tswv yim kho mob rau kev khaws cia ntawm RKF

Feem ntau, yam cuam tshuam rau tus nqi ntawm RKF(residual raum ua haujlwm)Kev poob yog tsawg dua kawm thiab nkag siab hauv HD, piv nrog PD. Cov kev hloov pauv uas muaj feem cuam tshuam rau tus nqi qis ntawm RKF hauv HD cov neeg mob tau sau tseg nyob rau hauv Table 2 thiab suav nrog cov xwm txheej thiab kev sib txuam. Cov pov thawj hais txog cov tswv yim kho mob rau kev khaws cia ntawm RKF hauv HD yog txwv, txawm hais tias muaj qee cov pov thawj tias RKF poob tuaj yeem cuam tshuam los ntawm cov yam ntxwv ntawm HD tshuaj, suav nrog kev siv zog thiab zaus ntawm HD tswj (Table 2).30,31Kev zam ntawm intra-dialytic hypotension kuj tseem tuaj yeem pab ua ntej RKF.19,31Hauv cov neeg mob hloov lub raum tsis ua haujlwm, kev saib xyuas ntawm kev tiv thaiv kab mob yog txuam nrog kev khaws cia zoo dua ntawm RKF(residual raum ua haujlwm); hauv cov neeg mob PD,32Txawm li cas los xij, cov ntaub ntawv tsis muaj nyob ntawm qhov no hauv cov neeg mob HD. Kev siv ultrapure dialysisfluid tau tshaj tawm kom qeeb qhov poob ntawm RKF(residual raum ua haujlwm)hauv HD neeg mob.33Kev zam ntawm nephrotoxins xws li radiocontrastdye, non-steroidal anti-inflammatory tshuaj, thiab aminoglycosides raug qhia,34txawm tias cov ntaub ntawv ncaj qha ntawm qhov no tsis muaj.

table 2

Blockade ntawm renin-angiotensin system nrog angiotensin-hloov enzyme inhibitors thiab / los yog angiotensin receptorblockers tau pom nyob rau hauv ntau qhov kev sim randomized los pab khaws cia RKF(residual raum ua haujlwm)hauv cov neeg mob PD.35 Txawm li cas los xij, thaum muaj qee qhov kev soj ntsuam pov thawj tias kev siv cov tshuaj no cuam tshuam nrog kev khaws cia ntawm RKF hauv cov neeg mob HD, tsuas yog qhov kev sim randomized tswj tau ua hauv HD cov neeg mob pom tias kev kho irbesartan rau 1 xyoo tsis cuam tshuam rau qhov poob ntawm GFR lossis zis ntim.36

Incremental HD

Nws tseem tsis tshua muaj nyob hauv kev xyaum tam sim no los coj RKF(residual raum ua haujlwm)intoaccount thaum txiav txim siab HD tshuaj thiab txaus.Qhov no sib piv nrog PD, qhov twg RKF niaj hnub ntsuas thiab systematically pab rau kev ntsuas ntawm kev kho mob txaus. Kev koom ua ke ntawm RKF rau hauv HD tshuaj tau raug txhawb los ntawm qee cov neeg tshawb xyuas, thiaj li hu ua incremental HD, uas cov neeg mob uas muaj RKF ntau dua HD, thaum cov neeg mob tsis muaj RKF ua HD ntau dua. Qhov tseem ceeb, ob qho tib si K-DOQIand EBPG cov lus qhia txhawb nqa kev siv Incremental HDprescription muab ceev faj saib xyuas ntawm RKF yog ua. Nyob rau hauv qhov sib piv, tsis muaj tam sim no KHA-CARI cov lus qhia rau HD txaus, thiab yav dhau los versions ntawm cov kev taw qhia no tsis tau hais txog lub luag hauj lwm rau RKF. Tshwj xeeb, KDOQI cov lus qhia tau hais tias, rau cov neeg mob HD nrog KRU Ntau dua lossis sib npaug li 2 mL / min ib 1.73 m2, cov koob tshuaj HD tuaj yeem raug txo qis muab RKF ntsuas ib ntus kom tsis txhob muaj kev lim ntshav txaus.3 Ib yam li ntawd, EBPG pom zoo ntsuas RKF hauv HD cov neeg mob. siv cov ntsiab lus ntawm urea thiab creatinine clearances los kwv yees qhov seem ntawm GFR thiab muab cov lus pom zoo los muab qhov no rau hauv HD tshuaj kom tso cai rau tus neeg hloov kho ntawm daim ntawv tshuaj lim ntshav kom tau raws li qhov tsawg kawg nkaus rau kev lim ntshav txaus.4

Qhov cuam tshuam ntawm HD ntawm RKF

Ib qho kev txhawj xeeb uas tau raug tsa yog tias HDregimens hnyav dua tuaj yeem ua kom zoo dua ntawm RKF poob(residual raum ua haujlwm). Cov ntaub ntawv los ntawm Kev Tshawb Fawb Txog Kev Mob Ntshav Qab Zib (FHN) tau pom tias ntau zaus thaum hmo ntuj HD ntawm rau lub sijhawm hauv ib lub lis piam ua rau kev poob ntawm RKF, piv nrog tus qauv peb zaug hauv ib lub lis piam HD.30Nyob rau hauv FHN txoj kev tshawb nocturnal, 52 thiab67 feem pua ​​​​ntawm cov neeg mob uas tau txais ntau zaus nocturnal HD muaj zerourine ntim ntawm lub hlis 4 thiab 12, piv nrog 18 thiab 36 feem pua, feem, nyob rau hauv cov pa HD pawg. Lub koom haum no tsis pom nyob rau hauv FHN nquag niaj hnub kawm HD, qhov twg cov neeg mob muaj lub hauv paus qis RKF(residual raum ua haujlwm).

Obi et al. also compared the changes in renal urea clearance and urine volume between patients initiated on conventional thrice-weekly HD regimen and those initiated on incremental twice-weekly HD regimen for >6 lub lis piam tas mus li.37 Tag nrho ntawm 351 tus neeg mob HD incremental tau sib npaug rau 8068 tus neeg mob HD. Txij lub hli 3 mus txog rau lub hli 15, cov neeg mob uas tau pib ua ob zaug ib lub lim tiam muaj 16 feem pua ​​​​siab dua lub raum urea clearance (95 feem pua ​​​​CI, 5–28 feem pua ​​) dua li cov neeg uas tau txais 3 lub lis piam lim ntshav. Hauv txoj kev tshawb no, kev nce kev tuag tau pom hauv cov neeg mob ua ob zaug hauv ib lub lis piam HD nrog KRU Tsawg dua lossis sib npaug rau 3.0 mL/min ib 1.73 m2, tab sis nws tsis txawv rau cov neeg uas muaj KRU > 3.0 mL/min ib 1,73m2 ua.

Cov txiaj ntsig zoo sib xws tau pom nyob rau hauv kev tshawb fawb suav nrog suav nrog 85 qhov xwm txheej HD cov neeg mob nrog UO Ntau dua lossis sib npaug li 500 mL / hnub ntawm qhov pib.31 Tag nrho ntawm 30 tus neeg mob tau pib nrog HD ob zaug-lub lim tiam HD rau 6 lub hlis lossis ntev dua, thiab 55 tus neeg mob tau pib. thiab khaws cia rau peb-lub lim tiam HD kho. Kev xaiv cov neeg mob rau ob zaug-lub lim tiam HD tsis yog qhov sib txawv thiab tau txiav txim siab raws li kev kho mob, kev xaiv tus neeg mob, kev ua raws cai, thiab kev lag luam. Piv nrog rau pawg thib peb-lub lim tiam, HDgroup ob zaug-lub lim tiam tau pom tias muaj RKF qis dua(residual raum ua haujlwm)poob (10 feem pua ​​​​vs. 40 feem pua, P=0.03), tshwj xeeb tshaj yog nyob rau hauv thawj xyoo ntawm HD pib.

Intra-dialytic hypotension tau pom tias yog qhov ua tau ua rau kom nrawm nrawm ntawm RKF(residual raum ua haujlwm), nrog transientdrops hauv ntshav siab thaum lub sij hawm dialysis ua rau ischaemicinjury rau lub raum. Hauv kev soj ntsuam kev soj ntsuam yav tom ntej tau ua nyob rau hauv Taiwan, ob zaug-lub lim tiam HD tau cuam tshuam nrog kev poob qis hauv RKF raws li qhia los ntawm cov zis ntim thiab creatinine tshem tawm, uas tau ua raws li cov txiaj ntsig ntawm lwm cov kev tshawb fawb. Tsis tas li ntawd, qhov tshwm sim tsawg dua ntawm cov kab mob dialytichypotensive tau pom nyob rau hauv ob zaug-lub lim tiam HD pawg piv nrog cov pab pawg HD peb lub lis piam (0.26 ntxiv rau -0.49 zaug / hli vs 1.1{{12} } ntxiv rau -1.21 zaug / hli; P <>38

Txoj kev thiab kev nyab xeeb ntawm kev koom ua ke RKF rau hauv HD tshuaj

Txhawm rau suav RKF rau hauv HD tshuaj rau kev nce qib HD, RKF(residual raum ua haujlwm)clearance yuav tsum tau ntxiv rau dialyzerclearance los xam tag nrho clearance. Txawm li cas los xij, vim tias HD tsis sib cuam tshuam thaum RKF txuas ntxiv mus, RKF yuav tsum tau hloov mus rau qhov sib npaug sib npaug sib npaug los yog tshem tawm kev lim ntshav yuav tsum tau hloov mus rau qhov sib npaug sib npaug. Ntau txoj hauv kev tau raug npaj, tab sis tseem tsis tau muaj kev pom zoo thoob plaws ntiaj teb raws li txoj hauv kev zoo tshaj plaws. Cov kev xaiv muaj xws li hloov lub lim piam lim ntshav mus rau qhov sib npaug rau lub raum ureaclearance (EKRc), 39 siv tus qauv (ib lub lim tiam) Kt/V40, thiab hloov RKF mus rau qhov sib npaug sib npaug sib npaug (Kt / V).14 Cov ntsiab lus ntawm cov txheej txheem no dhau qhov kev txwv. ntawm qhov kev tshuaj xyuas no, thiab cov neeg nyeem raug xa mus rau cov ntaub ntawv tseem ceeb thiab lwm yam kev tshuaj xyuas.

Ib qho kev txhawj xeeb nrog kev nce qib HD yog qhov kev pheej hmoo siab dua ntawm cov txiaj ntsig tsis zoo cuam tshuam nrog HD tsis txaus. Qhov kev txhawj xeeb no cuam tshuam rau cov lus nug hauv ntiaj teb txog kev ntseeg tau ntawm txoj hauv kev los saib xyuas RKF(residual raum ua haujlwm), qhov xav tau rau cov neeg mob ua raws li lub sijhawm sau cov zis, thiab qhov xav tau rau cov kws kho mob kom nce qib HD koob tshuaj thaum RKF poob. Tsis muaj qhov kev sim loj randomized sib piv cov nce qib HD rau cov tshuaj HD raws li tus qauv.

Vilar et al. tau tshaj tawm cov txiaj ntsig ntawm 650 tus neeg mob qhov xwm txheej uas tau tswj hwm hauv qhov kev txhawb nqa siab-flux HD nyob rau hauv lub sijhawm 15- xyoo.14 Qhov kev tshawb pom tseem ceeb yog qhov txiaj ntsig zoo dua pom hauv cov neeg mob KRU Ntau dua lossis sib npaug li 1 mL / min ib 1.73 m2 , txawm hais tias cov neeg mob no tau txais kev kho mob qis dua ntawm HD. Thaum qhov no muab qee qhov kev lees paub rau kev nyab xeeb ntawm kev nce qib HD, qhov tsis muaj pab pawg tswj hwm rau kev kawm txwv nws qhov dav dav.

Zhang et al. kuj pom tsis muaj qhov sib txawv ntawm cov txiaj ntsig kev kho mob ntawm HD txaus, kev ntsuas biochemical, kev mob plawv, lossis kev pw hauv tsev kho mob ntawm ob zaug-lub lim tiam thiab peb-lub lim tiam HD pawg.31Txawm li cas los xij, lub zog ntawm txoj kev tshawb no tsuas yog txwv los ntawm nws cov qauv me me ntawm 85 qhov xwm txheej HD cov neeg mob.

Obi et al. tshuaj xyuas cov kev sib raug zoo ntawm incremental dialysis regimen thiab mortality risk.37 Nyob rau hauv survivalanalyses tom qab 1 xyoo, tsis muaj qhov txawv ntawm tag nrho cov-causemortality txaus ntshai txuam nrog incremental HD piv nrog cov pa HD. Kev soj ntsuam pab pawg, txawm li cas los xij, tau nthuav tawm 61 feem pua ​​​​ntawm kev pheej hmoo tuag ntau dua hauv cov neeg mob uas muaj qis dua KRU ntawm<3 ml/min="" per="" 1.73="" m2="" (hr="" 1.61,="" 95%="" ci="" 1.07–2.44)="" but="" not="" in="" those="" with="" kru="" >="" 3="" ml/min="" per="" 1.73="" m2="" (hr="" 0.99,="" 95%="" ci="" 0.76–1.28).="" limitations="" of="" this="" study="" include="" selection="" bias="" as="" patients="" who="" have="" lower="" kru="" and="" higher="" comorbidity="" burden="" were="" less="" likely="" to="" be="" prescribed="" an="" incremental="" regimen.="" in="" addition,="" the="" sample="" size="" of="" patients="" receiving="" the="" incremental="" regimen="" was="" relatively="" small,="" resulting="" in="" a="" wide="" confidence="" interval="" for="" the="" estimate.="" nonetheless,="" this="" study="" underscores="" the="" potential="" risks="" of="" twice-weekly="" dialysis="" in="" patients="" with="" minimal="" rkf="">(residual raum ua haujlwm).Qhov no zoo ib yam nrog rau lwm cov kev tshawb fawb qhia tias muaj kev tuag ntau ntxiv nrog kev lim ntshav ob zaug ib lub lim tiam thaum RKF(residual raum ua haujlwm)tsis muab tso rau hauv daim ntawv tshuaj.41

Txog cov txiaj ntsig tau pom nyob rau hauv qhov kev cia siab, multicentre kev soj ntsuam kev tshawb fawb los ntawm Hwang et al.42 Lawv pom tias muaj kev pheej hmoo ntawm kev tuag (HR 4.2; 95 feem pua ​​​​CI, 1.02–17.32, P=0.04) hauv cov neeg mob RKF ob zaug -weekly HD(n=113) piv nrog cov nrog RKF(residual raum ua haujlwm)undergoingthrice-lub lim tiam HD (n=137), txawm tias txaus dialysis doseand kua dej tswj. Cov kws sau ntawv tau tshaj tawm tias qhov no tuaj yeem cuam tshuam txog kev noj zaub mov tsis zoo (txo qis cov protein catabolic tus nqi) tau pom nyob rau hauv ob zaug ib lub lim tiam pab pawg ntawm 24 thiab 36 lub hlis thiab qhia tias muaj feem cuam tshuam lwm yam tshaj li RKF yuav tsum tau muab coj mus rau hauv tus account thaum sau npe ob zaug-lub lim tiam HD.

Hauv cov ntsiab lus, muaj ntau cov pov thawj qhia tias muaj ntau cov txiaj ntsig tau muab los ntawm RKF(residual raum ua haujlwm), xws li txhim kho cov kua dej sib npaug, kev noj zaub mov zoo, thiab kev tshem tawm cov kuab tshuaj zoo dua. Kev siv zog khaws cia RKF(residual raum ua haujlwm)muaj kev ncaj ncees, txawm tias yuav ua li cas thiaj ua tau qhov no tsis meej. Kev zam ntawm nephrotoxins hauv HD cov neeg mob nrog RKF tshuav yog qhia. Qee cov ntaub ntawv pov thawj qhia tias cov kev tswj hwm HD hnyav dua ua rau RKF poob(residual raum ua haujlwm), yog li qhov no yuav tsum tau coj mus rau hauv tus account, tshwj xeeb tshaj yog nyob ib puag ncig lub sijhawm ntawm HD pib. Kev hloov kho ntawm HD tshuaj noj rau hauv tus account RKF(residual raum ua haujlwm), incremental HD, tej zaum yuav muaj qhov zoo ntawm RKF khaws cia, lub neej zoo, thiab cov nqi kho mob, uas yuav tsum muaj kev sib npaug tiv thaiv kev pheej hmoo, suav nrog kev phom sij ntawm kev lim ntshav tsis txaus. Kev tshawb nrhiav txuas ntxiv yuav tsum tau ua kom zoo tshaj plaws khaws cia RKF hauv HD neeg mob thiab qhia meej lub luag haujlwm ntawm RKF(residual raum ua haujlwm)hauv kev txiav txim siab theoptimal HD tshuaj.

Cistanche products for kidney function

Cistanche khoom raulub raum ua haujlwm

Los ntawm: 'Qhov tseem ceeb ntawmresidual raum ua haujlwmhauv cov neeg mob hemodialysis 'los ntawmJESSICA KONG, et al

--- Nephrology 23 (2018) 1073–1080


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