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【medical-news】肾病患者尝试激进疗法：过夜渗析
Kidney patients try radical approach: Overnight dialysis
Medical study finds longer treatment while patients sleep offers better results
By Dorsey Griffith - Bee Medical Writer
Published 12:00 am PDT Wednesday, September 19, 2007
Story appeared in METRO section, Page B1
Lab tech Jesus Villegas, left, covers patient Thomas Ross, 42, with a blanket as Ross takes part in a new nocturnal dialysis program at the University Dialysis Clinic. Kidney patients sleep overnight while toxins are removed from their bloodstream.
Sacramento Bee/Paul Kitagaki Jr.
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His beloved Redskins' win over Philadelphia locked in, and his belly full after two slices of chicken-pineapple pizza, Thomas Ross needed only his blanket before closing his eyes and drifting off to sleep.
Six hours later, Ross awoke, still carefully tethered to a dialysis machine and feeling well-rested and ready for a full day of work.
It was an encouraging start to a radical new approach to dialysis for the 42-year-old Elk Grove man, one of a small group of Sacramento-area kidney failure patients who have chosen to get their dialysis while snoozing in leather recliners three nights a week.
The University Dialysis Clinic on Campus Commons Road, which began the nocturnal treatments last week, is a rarity in the United States and may be the only such program in Northern California.
Patients like Ross, who normally get dialysis in three- to four-hour increments three times a week, are being lured by mounting evidence that longer, more gentle dialysis delivered overnight not only allows them to lead more normal lives during the day, but can improve their overall health as well.
"Once I heard about this, I knew it was for me," said Ross, who works as a security guard and attends college in addition to raising two young sons. "It makes sense: By running the machine longer you get more toxins out of your body."
A study appearing in this week's issue of the Journal of the American Medical Association appears to back him up on that.
The research from the University of Calgary in Alberta, Canada, found that end-stage renal disease patients who received nocturnal hemodialysis six nights per week over six months got healthier compared with similar patients who received standard dialysis treatment.
Because of the relatively small numbers of participants, the Calgary study couldn't prove that the frequent, nocturnal treatments improved survival among kidney failure patients.
But those on the frequent nocturnal schedule did experience a significant decrease in the thickness of their heart muscle -- one correlate of survival -- and a reduction in need for medications to control high blood pressure.
"It does in fact look very promising to improve survival," said Dr. Alan Kliger, a nephrologist, Yale University professor, dialysis researcher and author of an editorial accompanying the JAMA study.
Hemodialysis is given to patients whose own kidneys no longer function. It works by taking a patient's blood, a few ounces at a time, through a special filter, removing fluid and toxins, then returning it to the body. Currently about 300,000 people with kidney failure undergo regular dialysis treatments in the United States; most eligible patients are on kidney transplant waiting lists.
Dr. Braden Manns, principal investigator on the Calgary study, said despite many efforts to find ways to reduce high mortality rates in kidney dialysis patients, none has made a difference.
"It's fairly disappointing, but not surprising given that with dialysis we probably remove about 10 percent of the toxins our kidneys normally remove," he said. "Nocturnal dialysis six nights a week provides three to four times the amount of dialysis."
In the Calgary study, half the patients got treatments six nights per week, for at least 6 hours per night, while the others received the standard amount of dialysis, three times per week.
By study's end, there was, on average, a difference of more than 15 grams in patient heart mass between those who had conventional dialysis and those who had the more intensive therapy. Blood pressures also were reduced significantly.
Nephrologist Matthew Mezger, one of the doctors seeing patients at Sacramento's University clinic, said because dialysis mimics actual kidney function, it makes sense that patients would improve with longer treatments.
Mezger is one of the doctors overseeing the nocturnal dialysis at the University clinic, which is owned by DaVita, a leading U.S. dialysis company.
He said while local patients will not be getting dialysis six nights per week as they did in the Calgary study, they should benefit from the three-night-per-week approach, which is still more than the conventional treatment time.
"With eight hours of dialysis there is better removal of body toxins and wastes, which include sodium, a major contributor to high blood pressure," he said. "This would most closely approximate having a transplant."
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作者:admin@医学,生命科学 2010-12-17 17:11
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