【摘要】目的调查维持性血液透析具有残余肾功能患者的流行病学特征；探讨影响残余肾功能的因素；研究残余肾功能评估生物学标志物；分析残余肾功能对远期预后的影响。方法维持性血液透析患者残余肾功能队列研究(Huashan Residual Kidney Function Cohort Study,HRKCS)是基于复旦大学附属华山医院门诊新入有残余肾功能维持性血液透析人群，具有医学数据库和生物样本资料的全样本前瞻性队列研究。2016 年1 月～2026 年12 月开展患者入组及随访。基线调查包括问卷访谈、体格检查、生化检测、残余肾功能检测和生物标本采集。随后对入组患者进行每3 个月1 次随访，采集透析、生化及转归数据。结果自2016 年1 月～2020 年1 月入组患者46 名，平均年龄为(61±18)岁，男性占50%，起始透析频率2 次/w 占57%，该部分患者在平均1.2 年随访期间，46%由2 次/w 透析逐步过渡到3 次/w。所有患者初始尿素氮清除率为(3.37±2.16)ml/(min·1.73m2)，1 年后的尿素氮清除率逐步下降至(1.81±2.05)
ml/(min·1.73m2)(Z=-5.924，P＜0.001)。所有患者第一年的透析并发症指标控制均稳定，在平均1.8 年随访期间，死亡率为1.2/100 人年，心血管事件发生率为8.5/100 人年。结论维持性血液透析残余肾功能队列57%采用递增透析方案，残余肾功能下降速度延缓，并发症控制理想，全因死亡风险低。本研究将提供中国维持性血液透析残余肾功能相关数据资料及生物样本资源，为残余肾功能研究提供基础数据和决策依据。
王梦婧
,
黄碧红
,
翁佳敏
,
施君
,
卢芳
,
张炜晨
,
王康杰
,
张敏敏
,
陈靖
. 血液透析患者残余肾功能队列研究设计及初步结果[J]. 中国血液净化, 2021
, 20(05)
: 297
-301
.
DOI: 10.3969/j.issn.1671-4091.2021.05.003
【Abstract】Objective To investigate the characteristics of maintenance hemodialysis patients with residual renal function (RRF), explore the influencing factors and biomarkers of RRF, and analyze the association of RRF on prognosis. Methods Huashan Residual Kidney Function Cohort Study (HRKCS) enrolled incident hemodialysis patients with RRF in out- patient clinic with a prospective cohort design. The enrollment and follow-up are conducted between January 2016 and December 2026. Questionnaire interview, physical examination, biochemical testing, RRF measurement, biological specimen collection, and outcome are included
in the baseline or follow-up survey. Results Forty-six incident patients were enrolled between January 2016 and January 2020. The average age of enrolled patients was (61±18) years old, with 50% males. 57 % of them were treated with 2 times/week hemodialysis. During a median follow-up of 1.2 years, 46% of patients with 2 time/week hemodialysis changed their hemodialysis frequency from 2 times/week to 3 times/week. All enrolled patients had an average initial urea nitrogen clearance rate of (3.37± 2.16) ml/(min·1.73m2) (Z=-5.924, P＜0.001), which decreased to (1.81±2.05)ml/(min·1.73m2) after onEyear hemodialysis. All patients had stable control of complications in the first year. During the average follow-up period of 1.8 years, the mortality rate was 1.2/100 person-years, and the incidence of cardiovascular events was 8.5/100 person-years. Conclusion 57% of the patients in this cohort initiated with incremental dialysis, which had benefits to delay the decline of residual renal function, control the complications, and decrease the risk of all-cause death. HRKCS establishes a fundamental database and guidance for RRF studies.
[1]O' Hare AM, Wong SP, Margaret K Yu, et al.Trends in the Timing and Clinical Context of Maintenance Dialysis Initiation[J].J Am Soc Nephrol, 2015, 26(8):1975-1981
[2] HEMODIALYSIS ADEQUACY WORK G.Clinical practice guidelines for hemodialysis adequacy, update 2006[J][J].Am J Kidney Dis, 2006, 48(Suppl 1):S2-90
[3]王鑫, 姜红岩, 杨卉, 等.不同残余肾功能对腹膜透析患者透析效能及病死率的影响[J].中国医师进修杂志, 2014, 37(16):61-63
[4]赵明, 李向东.残余肾功能对维持性血液透析患者营养状况及左心功能的影响[J].临床肾脏病杂志, 2011, 11(4):170-172
[5]程立新, 郭玉强.残余肾功能对维持性血液透析患者的影响[J].国际移植与血液净化杂志, 2009, 7(5):3-6
[6]翁佳敏, 黄碧红, 张炜晨, 等.维持性血液透析患者残余肾功能与症状困扰关系的研究[J].中国血液净化, 2019, 18(8):524-526
[7] Shafi T, Mullangi S, Toth-Manikowski SM, et al.Residual Kidney Function: Implications in the Era of Personalized Medicine[J]. [J].Semin Dial. , 2017 , 30(3):241-245
[8] van der Weerd NC, Grooteman MP, Bots ML, et al.Hepcidin-25 in chronic hemodialysis patients is related to residual kidney function and not to treatment with erythropoiesis stimulating agents[J].[J].PLoS One , 2012, 7(7):e39783-e39783
[9] Shafi T, Jaar BG, Plantinga LC, Fink NE, et al.Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study[J]. [J].Am J Kidney Dis, 2010, 56(2):348-358
[10] Ramkumar N, Beddhu S, Eggers P, et al.Patient preferences for in-center intense hemodialysis[J].[J].Hemodial Int, 2005, 9(3):281-295
[11]Termorshuizen F, Korevaar JC, Dekker Fw, et al.The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) 2[J].Am J Kidney Dis, 2003, 41(6):1293-1302
[12]Brener ZZ, Thijssen S, et al.The impact of residual renal function on hospitalization and motality in incident hemodialysis patients[J].Blood Purif, 2011, 31(4):243-251
[13]Maiorca R, Brunori G, Zubani R, et al.Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patientsA longitudinal study[J].Nephrol Dial Transplant, 1995, 10(12):2295-2305
[14] Obi Y, Streja E, Rhee CM, et al.Incremental hemodialysis, residual kidney function, and mortality risk in incident dialysis patients: a cohort study[J].[J]. Am J Kidney Dis, 2016, 68(2):256-265
[15] Termorshuizen F, Dekker FW, van Manen JG, et al: .Relative contribution of residual renal function and different measures of adequacy to survival in hemodialysis patients: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2[J][J].J Am Soc Nephrol, 2004, 15(4):1061-1070
[16]Bargman JM, Thorpe KE, Churchil DN, et al.Relative contribution of residual renal function and peirtoneal clearnace to adequacy of dialysis: a reanalysis of the CANUSA study[J].J Am Soc Nephrol, 2001, 12(10):2158-2162
[17] Leonard MB, Donaldson LA, Ho M, et al.A prospective cohort study of incident maintenance dialysis in children: an NAPRTC study[J]. [J].Kidney Int, 2003, 63(2):744-755
[18] Pérez-García R, Martín-Malo A, Fort J, et al, .Baseline characteristics of an incident hemodialysis population in Spain: results from ANSWER-a multicentre, prospective, observational cohort study[J][J].Nephrol Dial Transplant, 2009, 24(2):578-588
