血液透析患者的依从性对患者残余肾功能的影响

目的 随着临床研究的深入,认为残余肾功能对患者预后存在较大影响,本研究将探讨血液透析患者的依从性对残余肾功能的影响。 方法 选取2015年2-5月在温州医科大学附属第一医院血液透析中心行维持性血透且透析间期24小时尿量 ≥ 200 ml的患者62例,根据依从性评定标准分为依从性好和依从性差2组,过程中因为移植、转院、感染、手术等原因,剔除10例患者,余下52例患者,每组26例,比较2组患者分组时及1年后透析间期24小时尿量,透析前后肌酐(Scr)、尿素氮(BUN)、血红蛋白(Hb)、甲状旁腺激素(PTH)、血钾、血钙、血磷、血清铁、铁蛋白、铁饱和度、白蛋白、C反应蛋白(CPR)、总维生素D、总尿素清除率(Kt/V),每次透析间期体重增长率及透析前的血压。比较2组患者2015年5月和2016年5月的各项指标。 结果 1年后,依从性好的组较依从性差的组透析间期24小时尿量多,PTH、铁蛋白控制得更好,总维生素D高,透析间期体重增长少,差异有统计学意义(P<0.05);其他指标差异无统计学意义(P>0.05)。 结论 提高患者的依从性可以减少患者透析间期体重的增长率、尿量维持得更多更久,能保护患者的残余肾功能,延缓残余肾功能的降低。 

The impact of compliance on residual renal function in maintenance hemodialysis patients

Objective More and more researches have proved that residual renal function has a great influence on the prognosis of patients. This study will examine the impact of compliance on residual renal function in patients with maintenance hemodialysis. Methods Sixty-two cases of maintenance hemodialysis patients whose 24-hour urine outputs were equal to or more than 200 ml during dialysis interphase in the First Affiliated Hospital of Wenzhou Medical University from February, 2015 to May, 2016 were enrolled. Due to transplantation, transfer, infection and surgery, 10 patients drop out during follow-up. Patients were divided into two groups (good compliance group and bad compliance group, with 26 cases in each group) according to the compliance evaluation criteria. The 24-hour urine outputs during dialysis interphase, creatinine and blood urea nitrogen before and after dialysis, hemoglobin, parathormone, potassium, calcium, phosphorus, iron, ferritin, transferring saturation, albumin, C reactive protein, Kt/V, weight growth rate during every dialysis interphase, blood pressure before dialysis were compared at the beginning of follow-up and a year later. Results The good compliance group had more 24-hour urine outputs, better parathormone and ferritin, higher vitamin D, less weight growth rate during dialysis interphase compared with bad compliance group after one year, which had statistical significance (P<0.05). Conclusion Improved compliance can reduce weight gain during hemodialysis interval, maintain urine output and protect the residual renal function, delay the reduce of residual renal function in maintenance hemodialysis patients.