Hidden risks associated with conventional short intermittent hemodialysis:A call for action to mitigate cardiovascular risk and morbidity  

作　　者：Bernard Canaud Jeroen P Kooman Nicholas M Selby Maarten Taal Andreas Maierhofer Pascal Kopperschmidt Susan Francis Allan Collins Peter Kotanko 

机构地区：[1]Global Medical Office,Fresenius Medical Care,Bad Homburg 61352,Germany [2]Department of Nephrology,Montpellier University,Montpellier 34000,France [3]Department of Internal Medicine,Maastricht University,Maastricht 6229 HX,Netherlands [4]Centre for Kidney Research and Innovation,Academic Unit for Translational Medical Sciences,School of Medicine,University of Nottingham,Derby DE223DT,United Kingdom [5]Global Research Development,Fresenius Medical Care,Schweinfurt 97424,Germany [6]University of Nottingham,Nottingham NG72RD,United Kingdom [7]Renal Research Institute,Icahn School of Medicine at Mount Sinai,New York,NY 10065,United States

出　　处：《World Journal of Nephrology》2022年第2期39-57,共19页世界肾病学杂志（英文版）

摘　　要：The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many lives.Nevertheless,intermittent renal replacement therapy is also a source of recurrent stress for patients.Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities,increases cardiovascular risk,and exacerbates disease burden.Altering cycles of fluid loading associated with cardiac stretching(interdialytic phase)and then fluid unloading(intradialytic phase)likely contribute to cardiac and vascular damage.This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burdenof treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory,inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed thedialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidityassociated with conventional intermittent HD appears to be a priority for improving patientexperience and reducing disease burden. In this in-depth review, we summarize the hidden effectsof intermittent HD therapy, and call for action to improve delivered HD and develop treatmentschedules that are better tolerated and associated with fewer adverse effects.

关 键 词：End stage kidney disease Cardiovascular mortality Dialytic morbidity Circulatory stress Biologic storm Dialysis sickness Personalized medicine 

分 类 号：R73[医药卫生—肿瘤]