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家庭血液透析

Authors
Christopher R Blagg, MD, FRCP
Lionel U Mailloux, MD, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
付平, 主任医师，教授

引言

家庭血液透析于20世纪60年代早期始于波士顿、西雅图和伦敦[1-5]。此后的研究已显示，相较于采用其他透析方式的患者，采用一周3次的传统家庭血液透析的患者生存率增加[6-13]和生存质量改善[14-16]。且该方法的花费显著少于传统医疗中心血液透析[17-21]。

这些发现使一些研究者认为，家庭血液透析是除肾移植之外的最佳肾脏替代疗法。尽管家庭血液透析可带来这些明显的获益，但在美国，自1973年开始Medicare(美国“医疗照顾”保险) ESRD项目以来至2002年，在透析(prevalent dialysis)的终末期肾病(end-stage renal disease, ESRD)患者中采取家庭血液透析的患者比例稳步降低，到2002年为0.57%[22]。其他国家也表现出类似的变化(图 1和图 2)[23-25]。

自2002年起，美国所有透析患者中接受家庭血液透析的患者数目和百分比逐渐增加；截至2008年，有3826例患者(占1.09%)接受家庭血液透析[22]，初步估计到2010年这类患者的人数为5000-6000例。这一现象反映出，人们越来越关注更为频繁的家庭血液透析[26]。根据2013年美国肾脏病数据系统(United States Renal Data System, USRDS)关于2011例新透析(incident dialysis)患者的数据，家庭透析患者总人数已有所增加，其主要原因在于使用持续循环性腹膜透析的患者数量显著增加[27]。患者选择家庭血液透析时仍面临很多障碍[28]。 (参见下文‘家庭血液透析应用增加的障碍’)

家庭血液透析带来的患者生存和其他获益的相关问题，美国家庭血液透析法使用率的下降，以及更频繁每日日间血液透析和每日夜间血液透析(一般在家于夜间开展)的发展，将在此处及别处讨论[29]。有关如何进行每日短时日间家庭血液透析和夜间家庭血液透析的内容，将单独讨论。 (参见“家庭血液透析项目的构成和组织”和“夜间血液透析技术方面的问题”和“Short daily hemodialysis”)

新透析和在透析

在美国透析患者中，采用家庭血液透析患者的绝对数目和相对百分比从1971年的40%降至2002年的0.57%。根据2010年的USRDS报告，2008年，所有新透析患者中(incident dialysis patients)只有520例(0.51%)接受的是家庭血液透析治疗，而所有的在透析患者(prevalent dialysis patients)中有3826例(1.09%)患者接受的是家庭血液透析治疗(图 1和图 2)[22]。

         

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-18.
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