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夜间血液透析的结局

Author
Andreas Pierratos, MD, FRCPC
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
李春梅, 副主任医师

引言和概述

行维持性血液透析的患者死亡率极高[1]。还有极高的并发症发病率、相对较低的生存质量(部分原因是高度的依赖性和失业)，以及高医疗成本[2]。

血液透析(hemodialysis, HEMO)试验和墨西哥腹膜透析充分性(adequacy of peritoneal dialysis in Mexico, ADEMEX)试验发现，在一周3次方案的一般限制内或在腹膜透析模式中分别增加透析剂量并不能降低患者死亡率[3-6]。(参见“患者存活期和维持性透析”和“开具血液透析处方和评估血液透析的充分性”)制定更加强化的透析方案，提供了这类患者的并发症发病率和可能的死亡率改善的证据。例如，相较于一周3次的常规方案，持续时间更长和/或频率更高的透析与结局改善相关[7-11]。

鉴于上述发现，夜间血液透析(如，每夜长时间家庭血液透析)被作为常规透析的一种(可能)更合适替代方法，这是因为基于剂量、持续时间及频率，它能提供更好的透析。因为透析在每晚睡眠期间进行，所以可达到此目标[12]。

虽然在家整夜透析归功于Sheldon[13]，但Uldall于1994年在多伦多Wellesley医院率先开展每日夜间血液透析项目[12,14]。自此之后，其应用已被推广到加拿大、美国、澳大利亚和几个欧洲国家更多的医疗中心[15-18]。

对夜间血液透析的介绍，尤其是操作相关结局，将在此讨论。夜间血液透析的技术问题和每日短时血液透析的概述参见其他专题。 (参见“夜间血液透析技术方面的问题”和“Short daily hemodialysis”)

                        

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-21.
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References
Top
  1. USRDS 2015. Morbidity and Mortality. http://www.usrds.org/2014/view/v1_03.aspx (Accessed on July 31, 2015).
  2. Bell CM, Chapman RH, Stone PW, et al. An off-the-shelf help list: a comprehensive catalog of preference scores from published cost-utility analyses. Med Decis Making 2001; 21:288.
  3. Lowrie EG, Laird NM, Parker TF, Sargent JA. Effect of the hemodialysis prescription of patient morbidity: report from the National Cooperative Dialysis Study. N Engl J Med 1981; 305:1176.
  4. Hakim RM, Breyer J, Ismail N, Schulman G. Effects of dose of dialysis on morbidity and mortality. Am J Kidney Dis 1994; 23:661.
  5. Eknoyan G, Beck GJ, Cheung AK, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002; 347:2010.
  6. Paniagua R, Amato D, Vonesh E, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002; 13:1307.
  7. Saran R, Bragg-Gresham JL, Levin NW, et al. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. Kidney Int 2006; 69:1222.
  8. Charra B, Calemard E, Ruffet M, et al. Survival as an index of adequacy of dialysis. Kidney Int 1992; 41:1286.
  9. Buoncristiani U. Fifteen years of clinical experience with daily haemodialysis. Nephrol Dial Transplant 1998; 13 Suppl 6:148.
  10. Woods JD, Port FK, Orzol S, et al. Clinical and biochemical correlates of starting "daily" hemodialysis. Kidney Int 1999; 55:2467.
  11. Locatelli F, Buoncristiani U, Canaud B, et al. Dialysis dose and frequency. Nephrol Dial Transplant 2005; 20:285.
  12. Pierratos A, Ouwendyk M, Francoeur R, et al. Nocturnal hemodialysis: three-year experience. J Am Soc Nephrol 1998; 9:859.
  13. Shaldon S. Independence in maintenance haemodialysis. Lancet 1968; 1:520.
  14. Udall PR, Francoeur R, Ouwendyk M. Simplified nocturnal home hemodialysis (SNHHD). A new approach to renal replacement therapy. J Am Soc Nephrol 1994; 5:428.
  15. Lindsay RM, Daily/Nocturnal Dialysis Study Group. The London, Ontario, Daily/Nocturnal Hemodialysis Study. Semin Dial 2004; 17:85.
  16. Lockridge RS Jr, Spencer M, Craft V, et al. Nocturnal home hemodialysis in North America. Adv Ren Replace Ther 2001; 8:250.
  17. Agar JW, Somerville CA, Dwyer KM, et al. Nocturnal hemodialysis in australia. Hemodial Int 2003; 7:278.
  18. Kooistra MP. Frequent prolonged home haemodialysis: three old concepts, one modern solution. Nephrol Dial Transplant 2003; 18:16.
  19. Powell JR, Oluwaseun O, Woo YM, et al. Ten years experience of in-center thrice weekly long overnight hemodialysis. Clin J Am Soc Nephrol 2009; 4:1097.
  20. Chan CT, Floras JS, Miller JA, et al. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int 2002; 61:2235.
  21. Suri R, Depner TA, Blake PG, et al. Adequacy of quotidian hemodialysis. Am J Kidney Dis 2003; 42:42.
  22. Gotch FA. The current place of urea kinetic modelling with respect to different dialysis modalities. Nephrol Dial Transplant 1998; 13 Suppl 6:10.
  23. Pierratos A. Daily nocturnal home hemodialysis. Kidney Int 2004; 65:1975.
  24. Mucsi I, Hercz G, Uldall R, et al. Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis. Kidney Int 1998; 53:1399.
  25. Lockridge RS, Albert J, Anderson H, et al. Nightly Home Hemodialysis: Fifteen Months of Experience in Lynchburg, Virginia. Home Hemodial Int 1999; 3:23.
  26. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA 2007; 298:1291.
  27. Walsh M, Manns BJ, Klarenbach S, et al. The effects of nocturnal compared with conventional hemodialysis on mineral metabolism: A randomized-controlled trial. Hemodial Int 2010; 14:174.
  28. FHN Trial Group, Chertow GM, Levin NW, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med 2010; 363:2287.
  29. Daugirdas JT, Chertow GM, Larive B, et al. Effects of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol 2012; 23:727.
  30. Rocco MV, Lockridge RS Jr, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int 2011; 80:1080.
  31. Raj DS, Ouwendyk M, Francoeur R, Pierratos A. beta(2)-microglobulin kinetics in nocturnal haemodialysis. Nephrol Dial Transplant 2000; 15:58.
  32. Mohr PE, Neumann PJ, Franco SJ, et al. The case for daily dialysis: its impact on costs and quality of life. Am J Kidney Dis 2001; 37:777.
  33. McPhatter LL, Lockridge RS Jr, Albert J, et al. Nightly home hemodialysis: improvement in nutrition and quality of life. Adv Ren Replace Ther 1999; 6:358.
  34. Brissenden JE, Pierratos A, Ouwendyk M, Roscoe JM. Improvements in quality of life with Nocturnal Hemodialysis. J Am Soc Nephrol 1998; 9:168A.
  35. Manns BJ, Walsh MW, Culleton BF, et al. Nocturnal hemodialysis does not improve overall measures of quality of life compared to conventional hemodialysis. Kidney Int 2009; 75:542.
  36. Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clin J Am Soc Nephrol 2012; 7:782.
  37. Jablonski KL, Chonchol M. Frequent hemodialysis: a way to improve physical function? Clin J Am Soc Nephrol 2012; 7:707.
  38. McFarlane PA, Pierratos A, Bayoumi AM, Redelmeier DA. Estimating preference scores in conventional and home nocturnal hemodialysis patients. Clin J Am Soc Nephrol 2007; 2:477.
  39. Jassal SV, Devins GM, Chan CT, et al. Improvements in cognition in patients converting from thrice weekly hemodialysis to nocturnal hemodialysis: a longitudinal pilot study. Kidney Int 2006; 70:956.
  40. Kurella Tamura M, Unruh ML, Nissenson AR, et al. Effect of more frequent hemodialysis on cognitive function in the frequent hemodialysis network trials. Am J Kidney Dis 2013; 61:228.
  41. Pierratos A. Nocturnal home haemodialysis: an update on a 5-year experience. Nephrol Dial Transplant 1999; 14:2835.
  42. Chan C, Floras JS, Miller JA, Pierratos A. Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure. Nephrol Dial Transplant 2002; 17:1518.
  43. Jefferies HJ, Virk B, Schiller B, et al. Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning). Clin J Am Soc Nephrol 2011; 6:1326.
  44. Chan CT, Harvey PJ, Picton P, et al. Short-term blood pressure, noradrenergic, and vascular effects of nocturnal home hemodialysis. Hypertension 2003; 42:925.
  45. Chan CT, Li SH, Verma S. Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease. Am J Physiol Renal Physiol 2005; 289:F679.
  46. Yuen DA, Kuliszewski MA, Liao C, et al. Nocturnal hemodialysis is associated with restoration of early-outgrowth endothelial progenitor-like cell function. Clin J Am Soc Nephrol 2011; 6:1345.
  47. Chan CT, Jain V, Picton P, et al. Nocturnal hemodialysis increases arterial baroreflex sensitivity and compliance and normalizes blood pressure of hypertensive patients with end-stage renal disease. Kidney Int 2005; 68:338.
  48. Chan CT, Hanly P, Gabor J, et al. Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep. Kidney Int 2004; 65:661.
  49. Ferrario M, Raimann JG, Larive B, et al. Non-Linear Heart Rate Variability Indices in the Frequent Hemodialysis Network Trials of Chronic Hemodialysis Patients. Blood Purif 2015; 40:99.
  50. Tsuji H, Larson MG, Venditti FJ Jr, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996; 94:2850.
  51. Chan CT, Shen XS, Picton P, Floras J. Nocturnal home hemodialysis improves baroreflex effectiveness index of end-stage renal disease patients. J Hypertens 2008; 26:1795.
  52. Yuen D, Pierratos A, Richardson RM, Chan CT. The natural history of coronary calcification progression in a cohort of nocturnal haemodialysis patients. Nephrol Dial Transplant 2006; 21:1407.
  53. Ting GO, Kjellstrand C, Freitas T, et al. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis 2003; 42:1020.
  54. Kooistra MP, Vos J, Koomans HA, Vos PF. Daily home haemodialysis in The Netherlands: effects on metabolic control, haemodynamics, and quality of life. Nephrol Dial Transplant 1998; 13:2853.
  55. Schwartz DI, Pierratos A, Richardson RM, et al. Impact of nocturnal home hemodialysis on anemia management in patients with end-stage renal disease. Clin Nephrol 2005; 63:202.
  56. Ornt DB, Larive B, Rastogi A, et al. Impact of frequent hemodialysis on anemia management: results from the Frequent Hemodialysis Network (FHN) Trials. Nephrol Dial Transplant 2013; 28:1888.
  57. Bugeja AL, Chan CT. Improvement in lipid profile by nocturnal hemodialysis in patients with end-stage renal disease. ASAIO J 2004; 50:328.
  58. Perl J, Unruh ML, Chan CT. Sleep disorders in end-stage renal disease: 'Markers of inadequate dialysis'? Kidney Int 2006; 70:1687.
  59. Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001; 344:102.
  60. Hanly PJ, Gabor JY, Chan C, Pierratos A. Daytime sleepiness in patients with CRF: impact of nocturnal hemodialysis. Am J Kidney Dis 2003; 41:403.
  61. Ikizler TA, Flakoll PJ, Parker RA, Hakim RM. Amino acid and albumin losses during hemodialysis. Kidney Int 1994; 46:830.
  62. Pierratos A, Ouwendyk M, Rassi M. Total Body Nitrogen Increases on Nocturnal Hemodialysis (Abstract). J Am Soc Nephrol 1999; 10:299A.
  63. Spanner E, Suri R, Heidenheim AP, Lindsay RM. The impact of quotidian hemodialysis on nutrition. Am J Kidney Dis 2003; 42:30.
  64. Kaysen GA, Greene T, Larive B, et al. The effect of frequent hemodialysis on nutrition and body composition: frequent Hemodialysis Network Trial. Kidney Int 2012; 82:90.
  65. Pierratos A, Hercz G, Sherrard DJ, et al. Calcium, Phosphorus Metabolism and Bone Pathology on Long Term Nocturnal Hemodialysis. J Am Soc Nephrol 2001; 12:274A.
  66. Al-Hejaili F, Kortas C, Leitch R, et al. Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration. J Am Soc Nephrol 2003; 14:2322.
  67. Toussaint N, Boddington J, Simmonds R, et al. Calcium phosphate metabolism and bone mineral density with nocturnal hemodialysis. Hemodial Int 2006; 10:280.
  68. Kim SJ, Goldstein M, Szabo T, Pierratos A. Resolution of massive uremic tumoral calcinosis with daily nocturnal home hemodialysis. Am J Kidney Dis 2003; 41:E12.
  69. Nessim SJ, Jassal SV, Fung SV, Chan CT. Conversion from conventional to nocturnal hemodialysis improves vitamin D levels. Kidney Int 2007; 71:1172.
  70. Barua M, Hladunewich M, Keunen J, et al. Successful pregnancies on nocturnal home hemodialysis. Clin J Am Soc Nephrol 2008; 3:392.
  71. Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol 2014; 25:1103.
  72. Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant 2009; 24:2915.
  73. Johansen KL, Zhang R, Huang Y, et al. Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study. Kidney Int 2009; 76:984.
  74. Rocco MV, Daugirdas JT, Greene T, et al. Long-term Effects of Frequent Nocturnal Hemodialysis on Mortality: The Frequent Hemodialysis Network (FHN) Nocturnal Trial. Am J Kidney Dis 2015; 66:459.
  75. Lacson E Jr, Xu J, Suri RS, et al. Survival with three-times weekly in-center nocturnal versus conventional hemodialysis. J Am Soc Nephrol 2012; 23:687.
  76. Kuhlmann MK. The eternal (nocturnal) quest for better dialysis outcomes. J Am Soc Nephrol 2012; 23:571.
  77. Nesrallah GE, Lindsay RM, Cuerden MS, et al. Intensive hemodialysis associates with improved survival compared with conventional hemodialysis. J Am Soc Nephrol 2012; 23:696.
  78. Tennankore KK, Kim SJ, Baer HJ, Chan CT. Survival and hospitalization for intensive home hemodialysis compared with kidney transplantation. J Am Soc Nephrol 2014; 25:2113.
  79. McFarlane PA. Reducing hemodialysis costs: conventional and quotidian home hemodialysis in Canada. Semin Dial 2004; 17:118.
  80. McFarlane PA, Pierratos A, Redelmeier DA. Cost savings of home nocturnal versus conventional in-center hemodialysis. Kidney Int 2002; 62:2216.
  81. Kroeker A, Clark WF, Heidenheim AP, et al. An operating cost comparison between conventional and home quotidian hemodialysis. Am J Kidney Dis 2003; 42:49.
  82. McFarlane PA, Bayoumi AM, Pierratos A, Redelmeier DA. The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis. Kidney Int 2003; 64:1004.
  83. Klarenbach S, Tonelli M, Pauly R, et al. Economic evaluation of frequent home nocturnal hemodialysis based on a randomized controlled trial. J Am Soc Nephrol 2014; 25:587.
  84. McFarlane PA, Bayoumi AM, Pierratos A, Redelmeier DA. The impact of home nocturnal hemodialysis on end-stage renal disease therapies: a decision analysis. Kidney Int 2006; 69:798.