Effect of incremental hemodialysis on renal function, microinflammation and mortality in end-stage renal disease patients

doi:10.3877/cma.j.issn.2095-3216.2022.04.003

Abstract

Abstract:

Objective

To investigate the effect of incremental hemodialysis (IHD) on renal function, microinflammation, and mortality in end-stage renal disease (ESRD) patients.

Methods

A total of 84 ESRD patients who received HD treatment in our hospital from July 2017 to June 2021 were selected. By means of the random number table method, the patients were divided into the incremental group (n=42) and the routine group (n=42). Before and 6 months after the treatment, the following indexes were observed, including dialysis adequacy, survival, BUN, cystatin C (CysC), serum creatinine (Scr), residual urine volume (RUV), urea nitrogen reduction rate (URR), Kt/V, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and β2 microglobulin (β2-MG), as well as adverse reactions during dialysis.

Results

Compared with the routine group, the incremental group showed higher dialysis adequacy rate and lower mortality rate (P<0.05). After 6 months of the treatment, compared with the routine group, the incremental group displayed lower levels of BUN, CysC, Scr, and RUV (P<0.05), higher levels of URR and Kt/V (P<0.05), and lower levels of serum CRP, IL-6, TNF-α and β2-MG (P<0.05), as well as lower rate of adverse reactions (P<0.05).

Conclusion

IHD could protect the residual kidney function of ESRD patients, inhibit the body′s microinflammation, and reduce both the adverse reaction rate and mortality rate.

Key words: Incremental hemodialysis, End-stage renal disease, Renal function, Microinflammation, Mortality rate

Tingyan Wang, Yingjiao Shen, Aiping Wang, Mingfeng Yao. Effect of incremental hemodialysis on renal function, microinflammation and mortality in end-stage renal disease patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2022, 11(04): 197-201.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2022.04.003

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2022/V11/I04/197

Figures/Tables 5

References 21

[1]	Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis [J]. Nephrol Dial Transplant, 2018, 33(Suppl 3): iii35-iii40.
[2]	Khan S, Rosner MH. Peritoneal dialysis for patients with end-stage renal disease and liver cirrhosis [J]. Perit Dial Int, 2018, 38(6): 397-401.
[3]	Davey CH, Webel AR, Sehgal AR, et al. Fatigue in individuals with end-stage renal disease [J]. Nephrol Nurs J, 2019, 46(5): 497-508.
[4]	Dhondup T, Qian Q. Electrolyte and acid-base disorders in chronic kidney disease and end-stage kidney failure [J]. Blood Purif, 2017, 43(1-3): 179-188.
[5]	Garofalo C, Borrelli S, De Stefano T, et al. Incremental dialysis in ESRD: systematic review and meta-analysis [J]. J Nephrol, 2019, 32(5): 823-836.
[6]	Vassalotti JA, Stevens LA, Levey AS. Testing for chronic kidney disease: a position statement from the National Kidney Foundation [J]. Am J Kidney Dis, 2007, 50(2): 169-180.
[7]	Welles CC, Cervantes L. Hemodialysis care for undocumented immigrants with end-stage renal disease in the United States [J]. Curr Opin Nephrol Hypertens, 2019, 28(6): 615-620.
[8]	Chazot C, Jean G. End-stage kidney patients require hemodialysis therapy full start [J]. Blood Purif, 2019, 47(1-3): 214-222.
[9]	Tattersall J. Residual renal function in incremental dialysis [J]. Clin Kidney J, 2018, 11(6): 853-856.
[10]	Li T, Wilcox CS, Lipkowitz MS, et al. Rationale and strategies for preserving residual kidney function in dialysis patients [J]. Am J Nephrol, 2019, 50(6): 411-421.
[11]	Tangvoraphonkchai K, Davenport A. Increasing haemodialytic clearances as residual renal function declines: an incremental approach [J]. Blood Purif, 2017, 44(3): 217-226.
[12]	Soares E, Valério P, Abrantes C, et al. An unexpected cause of residual renal function loss [J]. Perit Dial Int, 2020, 40(4): 422-424.
[13]	Shen Q, Fang X, Zhai Y, et al. Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic peritoneal dialysis [J]. Perit Dial Int, 2020, 40(4): 368-376.
[14]	Murea M, Moossavi S, Garneata L, et al. Narrative review of incremental hemodialysis [J]. Kidney Int Rep, 2019, 5(2): 135-148.
[15]	Murea M, Kalantar-Zadeh K. Incremental and twice-weekly hemodialysis program in practice [J]. Clin J Am Soc Nephrol, 2020, 16(1): 147-149.
[16]	Benackova K, Saudan P. Incremental hemodialysis "less is more" also when starting hemodialysis? [J]. Rev Med Suisse, 2020, 16(683): 395-398.
[17]	Hazara AM, Bhandari S. Can incremental haemodialysis reduce early mortality rates in patients starting maintenance haemodialysis? [J]. Curr Opin Nephrol Hypertens, 2019, 28(6): 641-647.
[18]	Basile C, Davenport A, Mitra S, et al. Frontiers in hemodialysis: innovations and technological advances [J]. Artif Organs, 2021, 45(2): 175-182.
[19]	Golper TA. Incremental dialysis: review of recent literature [J]. Curr Opin Nephrol Hypertens, 2017, 26(6): 543-547.
[20]	Maraj M, Kusnierz-Cabala B, Dumnicka P, et al. Malnutrition, inflammation, atherosclerosis syndrome (MIA) and diet recommendations among end-stage renal disease patients treated with maintenance hemodialysis [J]. Nutrients, 2018, 10(1): 69.
[21]	Casino FG, Basile C. A user-friendly tool for incremental haemodialysis prescription [J]. Nephrol Dial Transplant, 2018, 33(6): 1046-1053.

基线资料	递增组(n＝42)	常规组(n＝42)	χ²/t值	P值
性别(男/女)	22/20	24/18	0.190	0.663
年龄(岁)	61.23±6.42	61.31±6.48	0.057	0.955
疾病类型(慢性肾小球肾炎/糖尿病肾病/高血压肾病)	20/17/5	23/15/4	0.445	0.800
体重(kg)	58.09±6.15	58.52±6.21	0.319	0.751
收缩压(mmHg)	142.61±4.20	142.64±4.23	0.033	0.974
舒张压(mmHg)	87.28±5.09	87.31±5.12	0.027	0.979
血红蛋白(g/L)	80.38±8.31	80.43±8.35	0.028	0.978
白蛋白(g/L)	4.29±0.45	4.32±0.47	0.299	0.766
血磷(mmol/L)	1.86±0.20	1.83±0.18	0.723	0.472
血钙(mmol/L)	2.06±0.23	2.08±0.25	0.382	0.704
iPTH(μg/L)	243.07±27.23	247.75±27.26	0.787	0.434
空腹血糖(mmol/L)	15.67±1.92	15.63±1.89	0.096	0.924
餐后2 h血糖(mmol/L)	27.09±2.83	27.01±2.81	0.130	0.897

基线资料	递增组(n＝42)	常规组(n＝42)	χ²/t值	P值
性别(男/女)	22/20	24/18	0.190	0.663
年龄(岁)	61.23±6.42	61.31±6.48	0.057	0.955
疾病类型(慢性肾小球肾炎/糖尿病肾病/高血压肾病)	20/17/5	23/15/4	0.445	0.800
体重(kg)	58.09±6.15	58.52±6.21	0.319	0.751
收缩压(mmHg)	142.61±4.20	142.64±4.23	0.033	0.974
舒张压(mmHg)	87.28±5.09	87.31±5.12	0.027	0.979
血红蛋白(g/L)	80.38±8.31	80.43±8.35	0.028	0.978
白蛋白(g/L)	4.29±0.45	4.32±0.47	0.299	0.766
血磷(mmol/L)	1.86±0.20	1.83±0.18	0.723	0.472
血钙(mmol/L)	2.06±0.23	2.08±0.25	0.382	0.704
iPTH(μg/L)	243.07±27.23	247.75±27.26	0.787	0.434
空腹血糖(mmol/L)	15.67±1.92	15.63±1.89	0.096	0.924
餐后2 h血糖(mmol/L)	27.09±2.83	27.01±2.81	0.130	0.897

指标	递增组(n＝42)	常规组(n＝42)	χ²值	P值
透析充分	36(85.71)	28(66.67)	4.150	0.042
死亡	1(2.38)	8(19.05)	－	0.029

指标	递增组(n＝42)	常规组(n＝42)	χ²值	P值
透析充分	36(85.71)	28(66.67)	4.150	0.042
死亡	1(2.38)	8(19.05)	－	0.029

指标	时间	递增组	常规组	t值	P值
BUN(mmol/L)	治疗前	11.28±1.32	11.24±1.30	0.140	0.889
	治疗6个月后	7.19±0.74^a	8.87±0.92^a	8.409	<0.001
CysC(mg/L)	治疗前	2.98±0.31	2.96±0.30	0.301	0.765
	治疗6个月后	1.47±0.16^a	1.78±0.19^a	7.358	<0.001
Scr(μmol/L)	治疗前	99.87±10.23	98.95±10.20	0.413	0.681
	治疗6个月后	80.37±8.34^a	88.74±9.11^a	3.978	<0.001
URR(%)	治疗前	50.97±5.43	51.05±5.47	0.067	0.947
	治疗6个月后	71.07±7.34^a	65.92±6.84^a	3.327	0.001
Kt/V	治疗前	0.95±0.11	0.96±0.12	0.398	0.692
	治疗6个月后	1.42±0.16^a	1.30±0.15^a	3.546	0.001
RUV(ml)	治疗前	1649.07±171.29	1641.26±169.28	0.210	0.834
	治疗6个月后	379.98±40.32^a	553.76±58.95	15.769	<0.001

Please choose a citation manager

Content to export