updated guideline.Twice weekly hemodialysis prescribed using the updated guideline maintained quality of life and controlled fluid gain, potassium, and uremic solutes. Background The 2015 Update of the Kidney Disease Outcomes Quality Initiative (KDOQI) Guideline for Hemodialysis Adequacy increased the contribution of residual kidney function in calculating standard Kt/Vurea (stdKt/Vurea). However, no study has assessed the effect of prescribing twice weekly hemodialysis according to this guideline on patients' quality of life or uremic solute levels. Methods Twenty six hemodialysis patients with average residual urea clearance (Kru) 4.7±1.8 ml/min and hemodialysis vintage of 12±15 months (range 2 months to 4.9 years) underwent a cross-over trial comparing four weeks of twice weekly hemodialysis and four weeks of thrice weekly hemodialysis. Twice weekly hemodialysis was prescribed to achieve stdKt/Vurea 2.2 incorporating Kru using the 2015 KDOQI Guideline. Thrice weekly hemodialysis was prescribed to achieve spKt/Vurea 1.3 regardless of Kru. Quality of life and plasma levels of secreted uremic solutes and β2 microglobulin were assessed at the end of each period. Results Equivalence testing between twice and thrice weekly hemodialysis based on the Kidney Disease Quality of Life instrument (primary analysis) was inconclusive. Symptoms as assessed by the secondary outcomes Dialysis Symptom Index and Post-Dialysis Recovery Time were not worse with twice weekly hemodialysis. StdKt/Vurea was adequate during twice weekly hemodialysis (2.7±0.5), and ultrafiltration rate and plasma potassium were controlled with minimally longer treatment times (twice weekly: 195±20 versus thrice weekly: 191±17 minutes). Plasma levels of the secreted solutes and β2 microglobulin were not higher with twice weekly than thrice weekly hemodialysis. Conclusions Twice weekly hemodialysis can be prescribed using the higher contribution assigned to Kru by the 2015 KDOQI Guideline. With twice weekly hemodialysis, quality of life was unchanged, and the continuous function of the residual kidneys controlled fluid gain and plasma levels of potassium and uremic solutes without substantially longer treatment times. Clinical Trial registration number: NCT03874117....

中文翻译：

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每周两次与每周三次血液透析——试点交叉等效性试验


更新的指南。使用更新的指南规定每周两次血液透析可维持生活质量并控制液体摄入量、钾和尿毒症溶质。背景 2015 年肾脏病结果质量倡议 (KDOQI) 血液透析充分性指南的更新增加了残余肾功能在计算标准 Kt/Vurea (stdKt/Vurea) 中的贡献。然而，尚无研究评估根据本指南规定每周两次血液透析对患者生活质量或尿毒症溶质水平的影响。方法 对 26 名平均残余尿素清除率 (Kru) 4.7±1.8 ml/min、血液透析周期为 12±15 个月（范围 2 个月至 4.9 年）的血液透析患者进行了一项交叉试验，比较每周两次血液透析 4 周和每周两次血液透析 4 周的情况。每周三次血液透析。使用 2015 年 KDOQI 指南，每周进行两次血液透析，以达到结合 Kru 的 stdKt/Vurea 2.2。无论 Kru 如何，每周进行三次血液透析以达到 spKt/Vurea 1.3。在每个时期结束时评估生活质量以及分泌的尿毒症溶质和β2微球蛋白的血浆水平。结果 基于肾脏疾病生活质量工具（初步分析）的每周两次和三次血液透析之间的等效性测试尚无结论。通过次要结果透析症状指数和透析后恢复时间评估的症状在每周两次血液透析中并没有恶化。 StdKt/Vurea 在每周两次血液透析期间是足够的 (2.7±0.5)，并且超滤率和血浆钾通过尽可能长的治疗时间得到控制（每周两次：195±20 相对于每周三次：191±17 分钟）。 每周两次血液透析的血浆分泌溶质和β2微球蛋白水平并不高于每周三次血液透析。结论 使用 2015 年 KDOQI 指南分配给 Kru 的较高贡献可以规定每周两次血液透析。每周两次血液透析，生活质量没有改变，残余肾脏的持续功能控制了液体摄入量以及钾和尿毒症溶质的血浆水平，而无需显着延长治疗时间。临床试验注册号：NCT03874117....