{"id":5312,"date":"2023-07-17T20:31:57","date_gmt":"2023-07-18T01:31:57","guid":{"rendered":"https:\/\/staging.advancedrenaleducation.com\/wparep\/asiapacific\/?post_type=article&p=5312"},"modified":"2023-07-17T21:58:29","modified_gmt":"2023-07-18T02:58:29","slug":"%e5%a4%a7%e5%9e%8b%e4%b8%96%e4%bb%a3%e7%a0%94%e7%a9%b6%e7%9a%84%e4%b8%ad%e9%96%93%e7%99%82%e6%95%88%e6%8c%87%e6%a8%99%e4%bb%a5%e5%8f%8a%e8%87%a8%e5%ba%8a%e4%b8%bb%e8%a6%81%e7%99%82%e6%95%88%e6%8c%87-l","status":"publish","type":"article","link":"https:\/\/staging.advancedrenaleducation.com\/wparep\/asiapacific\/article\/%e5%a4%a7%e5%9e%8b%e4%b8%96%e4%bb%a3%e7%a0%94%e7%a9%b6%e7%9a%84%e4%b8%ad%e9%96%93%e7%99%82%e6%95%88%e6%8c%87%e6%a8%99%e4%bb%a5%e5%8f%8a%e8%87%a8%e5%ba%8a%e4%b8%bb%e8%a6%81%e7%99%82%e6%95%88%e6%8c%87-l\/","title":{"rendered":"\u5927\u578b\u4e16\u4ee3\u7814\u7a76\u7684\u4e2d\u9593\u7642\u6548\u6307\u6a19\u4ee5\u53ca\u81e8\u5e8a\u4e3b\u8981\u7642\u6548\u6307\u6a19\u6307\u6a19"},"content":{"rendered":"

\u4e00\u4e9b\u4e16\u4ee3\u7814\u7a76\u5f37\u8abf\u91cd\u8981\u7684\u81e8\u5e8a\u7d42\u9ede\u6307\u6a19 (\u660e\u78ba\u7684\u6307\u6a19)\uff0c\u4e26\u6307\u51faHDF\u53ef\u4ee5\u589e\u52a0\u60a3\u8005\u7684\u5b58\u6d3b (1-3)\u3002\u9019\u4e9b\u4e3b\u8981\u7d50\u679c\u6574\u7406\u5728\u4e0b\u8868\u4e2d\u3002\u5728\u6b64\u7ae0\u7bc0\u4e2d\uff0c\u6211\u5011\u63d0\u4f9b\u4e86\u6700\u65b0\u4ee5\u53ca\u986f\u8457\u7684\u7d50\u679c\u5f59\u6574\u3002<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\u6587\u737b<\/strong><\/td>\n\u7814\u7a76\u8a2d\u8a08<\/strong><\/td>\n\u814e\u81df\u66ff\u4ee3\u7642\u6cd5<\/strong><\/td>\n\u75c5\u4eba\u6578<\/strong><\/td>\n\u6548\u679c<\/strong>\/ <\/strong>\u4e3b\u8981\u7d42\u9ede<\/strong><\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Canaud\u00a0et al.<\/em>\u00a0(DOPPS)\u00a04<\/sup><\/td>\nProspective
\nobservational<\/td>\n		LF\/HF-HD \u2b0c olHDFpost<\/td>\n2165<\/td>\nHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387 (35%)<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Jirka et al.\u00a02<\/sup><\/td>\nRetrospective
\nobservational<\/td>\n		HF-HD \u2b0c olHDFpost<\/td>\n2564<\/td>\nHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387 \u00a0(37%)<\/td>\n<\/tr>\n
Bosch\u00a0et al.<\/em>\u00a03<\/sup><\/td>\nRetrospective
\nobservational<\/td>\n		HF-HD \u2b0c Double
\nhigh-flux HDF<\/td>\n		183<\/td>\n\u6bd4\u8f03USRDS\u7d50\u679c\uff0cHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387(60%)<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Panichi\u00a0et al<\/em>. (RISCAVID)\u00a06<\/sup><\/td>\nProspective
\nobservational<\/td>\n		HF-HD \u2b0cHDFpost<\/td>\n757<\/td>\nIHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387(22%)<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Vilar\u00a0et al.<\/em>\u00a01<\/sup><\/td>\nRetrospective
\nobservational<\/td>\n		HF-HD \u2b0cHDFpost<\/td>\n858<\/td>\nHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387 (34%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
HF High-Flux; LF Low-Flux; HD hemodialysis; HDF hemodiafiltration: ol-HDF online hemodiafiltration; USRDS United States Renal Data System<\/h6>\n

\u5728\u524d\u77bb\u6027\u7684Dialysis Outcomes and Practice Patterns Study (DOPPS)\u4e2d\uff0c\u9996\u5148\u767c\u73fe\u60a3\u8005\u4f7f\u7528\u8f03\u9ad8\u5bb9\u91cf\u88dc\u5145\u6db2\u7684HDF (15\u201325 L\/\u6b21)\uff0c\u76f8\u8f03\u65bc\u4f4e\u900f\u91cfHD\uff0c\u53ef\u4ee5\u6e1b\u5c1135%\u7684\u6b7b\u4ea1 (4)\u3002\u7136\u800c\uff0c\u9019\u500b\u5283\u6642\u4ee3\u7684\u767c\u73fe\u6c92\u6709\u8fa6\u6cd5\u5728DOPPS\u66f4\u65b0\u7684\u8cc7\u6599\u5206\u6790\u4e2d\u88ab\u78ba\u8a8d (5)\u3002<\/p>\n

RISCAVID\u5247\u662f\u4e00\u500b\u524d\u77bb\u6027\u3001\u591a\u4e2d\u5fc3\u53c3\u8207\u7684\u767b\u8a18\u7814\u7a76\uff0c\u4e3b\u8981\u662f\u63a2\u8a0eHD\u60a3\u8005\u7684\u98a8\u96aa\u56e0\u5b50\uff0c\u4ee5\u53ca\u4e0d\u540cHD\u900f\u6790\u6a21\u5f0f\u7684\u5f71\u97ff (6)\u3002\u6b64\u7814\u7a76\u524d\u77bb\u6027\u7684\u8ffd\u8e64\u4e86\u5171757\u4f4dHD\u60a3\u8005\u6700\u957730\u500b\u6708\uff0c\u4ee5\u4e86\u89e3\u4ed6\u5011\u7684\u6574\u9ad4\u6b7b\u4ea1\u7387\u3001\u4ee5\u53ca\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\uff1b\u4e5f\u540c\u6642\u76e3\u6e2c\u71df\u990a\u6a19\u8a18\u3001\u8ca7\u8840\u72c0\u6cc1\u3001\u4ee5\u53ca\u654f\u611f\u7684\u767c\u708e\u751f\u7269\u6a19\u8a18\u3002\u75c5\u4eba\u4f9d\u64da\u4e09\u7a2e\u814e\u81df\u66ff\u4ee3\u7642\u6cd5\u88ab\u5206\u70ba\u4e09\u7d44: \u6a19\u6e96\u7684bicarbonate HD (BHD) (n = 424)\u3001\u4f4e\u5bb9\u91cfHDF (bag HDF) (n = 204)\u3001\u4ee5\u53ca\u7dda\u4e0aHDF (n = 129)\uff0c\u5176\u8f38\u6ce8\u5bb9\u91cf\u5206\u5225\u70ba\u6bcf\u6b21\u5e73\u574714L\u820723L\u3002Cox\u6bd4\u4f8b\u98a8\u96aa\u8ff4\u6b78\u548c\u591a\u56e0\u5b50\u5206\u6790\u4ee5\u76f8\u5c0d\u6b7b\u4ea1\u98a8\u96aa\u5206\u6790\u767c\u73fe\uff0c\u6574\u9ad4\u548c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u5206\u5225\u70ba12.9%\/\u5e74\u548c5.9%\/\u5e74\u3002\u75c5\u60a3\u5408\u4f75\u9ad8\u6578\u503c\u7684CRP\u548c\u767c\u708e\u524d\u671f\u7d30\u80de\u7d20\uff0c\u6703\u589e\u52a0\u5fc3\u8840\u7ba1\u98a8\u96aa (RR1.9)\u4ee5\u53ca\u6574\u9ad4\u6b7b\u4ea1\u7387 (RR2.57)\u3002\u591a\u56e0\u5b50\u5206\u6790\u5728\u7d93\u904e\u5408\u4f75\u75c7\u4ee5\u53ca\u53d7\u8a66\u8005\u80cc\u666f\u6821\u6b63\u4e4b\u5f8c\uff0c\u767c\u73fe\u9ad8CRP\u548cIL-6\u8207\u60a3\u8005\u6700\u58de\u7684\u7d50\u679c\u6709\u95dc\uff0c\u800cHDF\u5247\u8207\u60a3\u8005\u5b58\u6d3b\u7684\u7d2f\u7a4d\u6548\u76ca\u986f\u8457\u76f8\u95dc (6)\u3002<\/p>\n

\u6700\u65b0\u7684\u4e09\u500b\u5927\u578b\u4e16\u4ee3\u7814\u7a76\uff0c\u5305\u542b\u6cd5\u570b\u767b\u8a18\u8655\u7684REIN (7); \u6fb3\u6d32\u7d10\u897f\u862d\u767b\u8a18\u8655\u7684ANZ (8); \u65e5\u672c\u767b\u8a18\u8655\u7684JSDT (9)\uff0c\u5247\u63d0\u4f9b\u4e86\u6c92\u6709\u9078\u64c7\u6027\u504f\u5dee\u7684\u771f\u5be6\u4e16\u754c\u5be6\u969b\u4f7f\u7528\u60c5\u6cc1\u3002\u6574\u7406\u5982\u4e0b\u8868\u6240\u898b:<\/p>\n\n\n\n\n\n\n\n\n\n
\u6578\u64da\u767b\u8a18<\/strong><\/td>\n\u814e\u81df\u66ff\u4ee3\u7642\u6cd5<\/strong><\/td>\n\u75c5\u4eba\u6578<\/strong><\/td>\n\u6548\u679c<\/strong>\/ <\/strong>\u4e3b\u8981\u7d42\u9ede<\/strong><\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
French National Data
\nRegistry (REIN)\u00a07<\/sup><\/td>\n		HF-HD \u2b0c olHDFpost<\/td>\n28407<\/td>\nHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387\uff1a
\n\u6574\u9ad4\u6b7b\u4ea1\u7387 23%\uff1b\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387 34%<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Australia New-Zealand Dialysis
\nand Transplant Registry\u00a08<\/sup><\/td>\n		HF-HD \u2b0c olHDFpost<\/td>\n26961<\/td>\nHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387\uff1a
\n\u6574\u9ad4\u6b7b\u4ea1\u7387 21% (\u6fb3\u6d32)\u3001
\n12% (\u7d10\u897f\u862d)\uff1b
\n\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u738722% (\u50c5\u6fb3\u6d32)<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Japanese Society for Dialysis Therapy
\nNational Data Registry\u00a09<\/sup><\/td>\n		HF-HD \u2b0c olHDFpre<\/td>\n10000<\/td>\nHDF\u7d44\u589e\u52a0\u5b58\u6d3b\u7387\uff1a
\n\u6574\u9ad4\u6b7b\u4ea1\u7387 17%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
HF High-Flux; LF Low-Flux; HD hemodialysis; HDF hemodiafiltration: ol-HDF online hemodiafiltration; HDFpost postdilution HDF; HDFpre predilution HDF;\u00a0CV cardiovascular<\/h6>\n

\u7b2c\u4e00\u7bc7\u7814\u7a76\u8cc7\u6599\u53d6\u81eaFrench National Renal Epidemiology and Information Network (REIN) \u767b\u9304\u8cc7\u6599\uff0c\u53d6\u5f97\u4e86\u5728\u6cd5\u570b\u5f9e2008\u5e741\u67081\u65e5\u52302011\u5e7412\u670831\u65e5\u4f7f\u7528online HDF\u7684\u6b7b\u4ea1\u7387 (7)\uff0c\u4e26\u5728\u60a3\u8005\u548c\u9662\u6240\u6c34\u5e73\u9032\u884c\u4e86\u5206\u6790\u3002\u5728\u7e3d\u517128,403\u540d\u60a3\u8005\u4e2d\uff0c5,526\u4f4d\u63a5\u53d7HDF\uff0c\u4e2d\u4f4d\u6578\u70ba1.21\u5e74\uff1b2,254\u540d\u60a3\u8005\u53ea\u63a5\u53d7\u904eHDF\u3002\u7121\u95dc\u4e4e\u75c5\u60a3\u672c\u8eab\u6216\u662f\u9662\u6240\u7b49\u7d1a\uff0cHDF\u8207HD\u76f8\u6bd4\uff0c\u8207\u8f03\u4f4e\u7684\u6574\u9ad4\u6b7b\u4ea1\u7387\u53ca\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u6709\u95dc\uff0c\u5c24\u5176\u5728\u53ea\u4f7f\u7528HDF\u7684\u60a3\u8005\u4e2d\u6548\u76ca\u66f4\u986f\u8457\u3002<\/p>\n

\u7b2c\u4e8c\u7bc7\u7814\u7a76\u662f\u8490\u96c6\u6fb3\u6d32\u8207\u7d10\u897f\u862d\u7684\u79fb\u690d\u767b\u9304\u8cc7\u6599\uff0c\u6240\u6709\u57282000\u5e74\u52302014\u5e74\u958b\u59cbHD\u6cbb\u7642\u7684\u6fb3\u6d32\u3001\u7d10\u897f\u862d\u6210\u4eba\u60a3\u8005 (8)\u3002\u672c\u7814\u7a76\u7684\u4e3b\u8981\u7d50\u679c\u662f\u63a1\u7528\u6574\u9ad4\u6b7b\u4ea1\u7387\uff0c\u6b21\u8981\u7d50\u679c\u5247\u662f\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u3002\u7d50\u679c\u8a08\u7b97\u662f\u5f9e\u7b2c\u4e00\u6b21\u8840\u6db2\u900f\u6790\u6cbb\u7642\u5f8c\u958b\u59cb\u7b97\u8d77\uff0c\u4e26\u4f7f\u7528\u591a\u56e0\u5b50Cox\u8ff4\u6b78\u5206\u6790\uff0c\u75c5\u4eba\u65bc\u6c38\u4e45\u505c\u6b62HD\u6cbb\u7642\u62162014\u5e7412\u670831\u65e5\u88ab\u8a2d\u9650\u3002\u9019\u500b\u7814\u7a76\u5305\u542b\u4e8626,961\u4f4d\u60a3\u8005 (4110 HDF, 22,851 HD; 22,774 \u6fb3\u6d32, 4187 \u7d10\u897f\u862d)\uff0c\u8ffd\u8e645.31\u5e74(\u4e2d\u4f4d\u6578)\u3002\u8207\u6a19\u6e96HD\u76f8\u6bd4\uff0cHDF\u8207\u986f\u8457\u964d\u4f4e\u6574\u9ad4\u6b7b\u4ea1\u7387\u76f8\u95dc (\u6fb3\u6d32HR 0.79; \u7d10\u897f\u862dHR 0.88)\u3002\u7814\u7a76\u767c\u73feHDF\u8207\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u6e1b\u5c11\u606f\u606f\u76f8\u95dc (HR 0.78)\u3002\u5728\u5169\u500b\u570b\u5bb6\u767b\u9304\u8cc7\u6599\uff0c\u4e0d\u540c\u60a3\u8005\u6b21\u7fa4\u9ad4\u5982\u5e74\u9f61\u3001\u6027\u5225\u3001\u5171\u75c5\uff0cHDF\u7686\u6709\u8f03\u512a\u7684\u5b58\u6d3b\u7387\u3002<\/p>\n

\u6700\u5f8c\uff0c\u7b2c\u4e09\u500b\u7814\u7a76\u8cc7\u6599\u4f86\u81ea\u65e5\u672c\u7684Japanese Society for Dialysis Therapy Renal Data Registry\u8cc7\u6599\uff0c\u6b64\u7814\u7a76\u4f7f\u7528\u50be\u5411\u8a55\u5206\u5339\u914d\u4e16\u4ee3\u7814\u7a76 (propensity-matched cohort)\uff0c\u7814\u7a765\u5343\u5c0d\u60a3\u8005\u4f7f\u7528\u50b3\u7d71\u9ad8\u900f\u91cfHD\u6216\u524d\u7a00\u91cb\u6cd5HDF\uff0c\u4e26\u8ffd\u8e64\u4e00\u5e74(9)\uff0c\u6574\u9ad4\u6b7b\u4ea1\u7387\u4ee5\u53ca\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u4e5f\u5728\u6b64\u7814\u7a76\u4e2d\u88ab\u6bd4\u8f03\u3002HDF\u76f8\u8f03\u65bcHD\uff0c\u8207\u589e\u52a0\u6574\u9ad4\u5b58\u6d3b\u6709\u95dc (HR all cause-mortality 0.83)\uff0c\u4e26\u4e14\u6709\u589e\u9032\u5fc3\u8840\u7ba1\u5b58\u6d3b\u7387\u7684\u50be\u5411\u3002\u5728\u4f7f\u7528\u524d\u7a00\u91cb\u6cd5online HDF\u7684\u60a3\u8005\u4e2d\uff0c\u4f7f\u7528\u9ad8\u5bb9\u91cf\u88dc\u5145\u6db2\u8005 (\u226540.0 L\/\u6b21)\u76f8\u8f03\u65bc\u4f7f\u7528\u4f4e\u5bb9\u91cf\u88dc\u5145\u6db2 (<40.0 L\/\u6b21) \u6216HD\u60a3\u8005\uff0c\u6709\u52a9\u65bc\u6574\u9ad4\u4ee5\u53ca\u5fc3\u8840\u7ba1\u5b58\u6d3b\u7387\u7684\u8868\u73fe\u3002\u5728\u8207\u6574\u9ad4\u5b58\u6d3b\u7387\u589e\u9032\u7684\u76f8\u95dc\u6027\u4e0a\uff0c\u6700\u9069\u5408\u7684\u524d\u7a00\u91cb\u88dc\u5145\u6db2\u5bb9\u91cf\u63a8\u4f30\u662f\u572850.5 L\/\u6b21\u3002\u9019\u500b\u89c0\u5bdf\u6027\u7814\u7a76\u5efa\u8b70\uff0cHDF\uff0c\u5c24\u5176\u662f\u9ad8\u88dc\u5145\u6db2\u91cf\u7684HDF\uff0c\u8207\u6574\u9ad4\u6b7b\u4ea1\u7387\u548c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u7684\u964d\u4f4e\u6709\u95dc\u3002<\/p>\n

\u7c21\u800c\u8a00\u4e4b\uff0c\u9019\u4e9b\u5927\u578b\u7684\u767b\u8a18\u7814\u7a76\u53cd\u6620\u4e86\u8fd1\u671f\u81e8\u5e8a\u5be6\u8e10\u8cc7\u6599\u3001\u4ee5\u53ca\u6821\u6b63\u4e3b\u8981\u7684\u6df7\u6dc6\u56e0\u5b50\u5f8c\u7684\u5206\u6790\uff0c\u90fd\u53ef\u4ee5\u770b\u5230HDF\u76f8\u8f03\u65bc\u9ad8\u900f\u91cfHD\uff0c\u53ef\u4ee5\u986f\u8457\u63d0\u5347\u75c5\u60a3\u5b58\u6d3b\u9918\u547d (\u6700\u9ad8\u81f330%)\u3002\u800c\u4e14\uff0c\u6b64\u597d\u8655\u4e3b\u8981\u4f86\u81ea\u65bc\u6e1b\u5c11\u5fc3\u81df\u76f8\u95dc\u7684\u6b7b\u4ea1\u7387\uff0c\u4e14\u8207\u5c0d\u6d41\u5291\u91cf\u6709\u95dc\u3002<\/p>\n

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