Hemodialysis of the Future: Prolonged and/or Frequent Dialysis

未來的血液透析：延長透析時間及／或增加透析頻率

溫崧峰(Sung-Feng Wen)

《Acta Nephrologica》 16卷1期 (2002/01) Pp. 1-11

摘要

雖然近年來血液透析技術持續進展，在美國的血液透析病人整體預後卻相當不好，5年存活率只達到30%，所已為了找尋更好的血液透析模式，一些歐美的研究者發現延長透析時間或增加透析頻率可以改善病人預後。這些方法包括了法國Tassin的每週3次，每次8小時方法；義大利Lecce的每週4次方法；義大利Perugia的每日短時透析法；以及加拿大Toronto的夜間透析法等等。增加透析時間或次數可以清除更多溶質，平順的超過濾使高血壓更好控制，避免尿毒素回彈及不平衡症候，飲食可以更自由，而且神經認知功能也更好，另外，夜間透析法也可以不用降磷藥物就改善高血磷，改善中大分子 (如β2 -微小球蛋白)之移除，有效改善睡眠呼吸中止症候群，除此以外，所有這些透析方法都使病人存活率大幅改善，減少住院機會，而且改善生活品質，增進社會回歸，雖然這些結果都還只是個別經驗，而且病人也都經過篩選，但是病人絕佳的預後，卻必定值得我們多加注意而且將來應該進行大規模的正式研究來確立這些模式的優點，做為未來血液透析改善的依據。

關鍵字

血液透析 ； 長時血液透析 ； 頻繁血液透析 ； 每日血液透析 ； 夜間血液透析

並列摘要

Despite recent advances in hemodialysis (HD) technology. The overall outcome of patients on conventional HD remains miserably unsatisfactory with a 5-year patient survival rate of 30% in the United States. In search of better HD modalities, a number of investigators in Europe and North America have reported greatly improved outcome with prolonged and/or frequent RD. These include 8h, 3-times-weekly HD from Tassin, France, every-other-day or 4-times-weekly HD from Lecce, Italy, Short daily HD (SDHD) from Perugia, Italy, and nocturnal HD (NHD) from Toronto, Canada, with increasing number of other SDHD and NHD programs reported in recent years. The prolonged and/or frequent HD allows better clearance of solutes, smooth ultrafiltration with good control of hypertension, avoidance of solute rebound and disequilibrium symptoms, liberalization of diet with improved nutrition, and better neuro-cognitive function. In addition, NHD is associated with correction of hyperphosphatemia without the use of phosphate binders, improved removal of middle molecules such as β2 microglobulin, and effective control of sleep apnea. Above all, in all of these HD modalities, patient survival is remarkably improved with reduction in hospitalization, and the better quality of life leads to good rehabilitation. Although these reports are based on anecdotal experiences, many with selected groups of patients, the impressive improvement in patient outcome makes it worthwhile to further pursue large scale controlled studies for confirmation as well as for the future guide to improve HD modalities.

並列關鍵字

hemodialysis ； prolonged hemodialysis ； frequent hemodialysis ； daily hemodialysis ； nocturnal hemodialysis