尿毒症患者血液透析致残余肾功能减退相关因素分析

目的：分析血透致残余肾功能(RRF)减退的相关因素。方法：采用醋酸纤维素膜透析器(1.1及1.7 m2)行碳酸氢盐透析,并每月测定1次24 h尿量、肌酸酐水平、透析间期体质量增长量、透析清除率及透析中反应,共观察6-12个月。结果：原发于肾小球疾病者RRF较肾小管间质疾病者下降快;长期透析超滤超过4.0 kg/次者较小于4.0 kg/次者RRF下降快;透析6个月RRF减退幅度超过5 ml/min者透析并发症发生率与低于5 ml/min者相比差异不显著;采用大面积(1.7 m2)透析器治疗6个月后RRF下降幅度较采用中等面积透析器(1.1 m2)大。结论：大量超滤引起肾有效血流量降低,致肾缺血再灌注损伤,是造成血透初期残余肾功能丢失的主要因素;追求高效透析致渗透性利尿作用减弱,也是加速RRF减退的原因;肾小球疾病,尤其病变处于活动阶段,参与了RRF的丧失。

Study on relative factor for decline of residual renal function in patients treated by hemodialysis

Objective: To investigate relative factors for decline of residual renal function(RRF) in patients treated by hemodialysis and discuss protective measures of RRF. Methods: All patients were treated by bicarbonate hemodialysis. Twenty-four hour urine volume, rate of creatinine clearance, increase of body weight between 2 sessions of dialysis and complication of hemodialysis were observed during 6-12months. Results: The decrease of RRF associated with primary glomerular disease was quicker as compared with primary renal tubular intestine disease. The more volume of ultrafiltration is during hemodialysis, the faster decrease of RRF in chronic hemodialysis patients. RRF was more significantly decreased in groups adapted with 1.7m2 dialyzer than that in group with 1.1m2 dialyzer. Conclusion: High ultrafiltration by hemodialysis can induce decline of effective renal blood flow and result in ischemia and reperfusion injury, which may be the primary factor for decrease of RRF at the initial stage of hemodialysis. High effective dialysis had attenuant effect on osmotic diuresis by elimination of solute load and speed up decrease of RRF. Primary glomerular disease, especially on the active phase, also may contribute to decline of RRF.