荷兰乌得勒支大学医学中心Peter J. Blankestijn团队比较了肾功能衰竭患者高剂量血液透析过滤或血液透析对死亡率的影响。2023年6月16日出版的《新英格兰医学杂志》发表了该成果。

几项研究表明，与标准血液透析相比，肾衰竭患者可能受益于高剂量血液透析过滤。然而，鉴于已发表的各种研究的局限性，还需要更多的数据。

研究组进行了一项务实、多国、随机、对照的试验，招募接受高通量血液透析至少3个月的肾衰竭患者。所有患者被认为是每次治疗至少23升对流容量的候选者（根据高剂量血液透析过滤的要求），并且能够完成患者报告的结果评估。患者被分配接受高剂量血液透析过滤或继续进行常规高通量血液透析。主要结局是全因死亡。关键次要结局是病因特异性死亡、致命或非致命心血管事件的复合、肾移植和复发性全因或感染相关住院。

共有1360名患者接受了随机分组：683名接受高剂量血液透析过滤，677名接受高通量血液透析。中位随访时间为30个月（四分位间距为27-38）。血液透析滤过组试验期间的平均对流量为每次25.3升。高剂量血液透析过滤组有118名患者（17.3%）和血液透析组有148名患者（21.9%）全因死亡（危险比为0.77）。

研究结果表明，在肾衰竭导致肾脏替代治疗的患者中，与传统的高通量血液透析相比，使用高剂量血液透析过滤导致全因死亡风险较低。

附：英文原文

Title: Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure | NEJM

Author: Peter J. Blankestijn, M.D.,, Robin W.M. Vernooij, Ph.D.,, Carinna Hockham, Ph.D.,, Giovanni F.M. Strippoli, M.D.,, Bernard Canaud, M.D.,, Jrgen Hegbrant, M.D.,, Claudia Barth, M.D.,, Adrian Covic, M.D.,, Krister Cromm, M.Sc.,, Andrea Cucui, M.D.,, Andrew Davenport, M.D.,, Matthias Rose, M.D.,, Marietta Trk, M.D.,, Mark Woodward, Ph.D.,, and Michiel L. Bots, M.D.

Issue&Volume: 2023-06-16

Abstract:

Background

Several studies have suggested that patients with kidney failure may benefit from high-dose hemodiafiltration as compared with standard hemodialysis. However, given the limitations of the various published studies, additional data are needed.

Methods

We conducted a pragmatic, multinational, randomized, controlled trial involving patients with kidney failure who had received high-flux hemodialysis for at least 3 months. All the patients were deemed to be candidates for a convection volume of at least 23 liters per session (as required for high-dose hemodiafiltration) and were able to complete patient-reported outcome assessments. The patients were assigned to receive high-dose hemodiafiltration or continuation of conventional high-flux hemodialysis. The primary outcome was death from any cause. Key secondary outcomes were cause-specific death, a composite of fatal or nonfatal cardiovascular events, kidney transplantation, and recurrent all-cause or infection-related hospitalizations.

Results

A total of 1360 patients underwent randomization: 683 to receive high-dose hemodiafiltration and 677 to receive high-flux hemodialysis. The median follow-up was 30 months (interquartile range, 27 to 38). The mean convection volume during the trial in the hemodiafiltration group was 25.3 liters per session. Death from any cause occurred in 118 patients (17.3%) in the hemodiafiltration group and in 148 patients (21.9%) in the hemodialysis group (hazard ratio, 0.77; 95% confidence interval, 0.65 to 0.93).

Conclusions

In patients with kidney failure resulting in kidney-replacement therapy, the use of high-dose hemodiafiltration resulted in a lower risk of death from any cause than conventional high-flux hemodialysis.

DOI: 10.1056/NEJMoa2304820

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2304820