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More of the same: improving outcomes through intensive hemodialysis.

机译：更重要的是：通过强化血液透析改善结果。

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The typical dialysis patient faces both a poor quality of life and a significantly shortened survival. This is often blamed on "uremia." However, defining the clinical entity of uremia is surprisingly difficult. It represents the clinical sequelae of the effects of retention products, other effects of renal disease, and the effects of other comorbid conditions. The list of retention products that could act as uremic toxins is lengthy, but it would appear that urea itself does not contribute significantly to the uremic state. Larger molecular weight substances are likely the major contributors to the uremic milieu. Regardless of the causes, the uremic state persists in many patients who are reaching their dialysis adequacy targets as defined by urea clearance. This raises the possibility that more intensive hemodialysis could improve patient outcomes. Hemodialysis can be intensified by increasing dialysis efficiency without changing duration or frequency. Alternatively, hemodialysis duration, frequency, or both can be increased. All intensification methods increase small solute removal, but the removal of larger molecular weight retention products depends more upon treatment time. Modalities such as short daily hemodialysis, long intermittent hemodialysis, and quotidian nocturnal hemodialysis have been associated with a variety of clinical improvements, as well as improvements in quality of life and a lower standardized mortality ratio. However, the HEMO study approach of intensifying small solute clearance without significant modifications of the dialysis schedule does not appear to be effective. Future research will help to define the optimal treatment duration and frequency in hemodialysis patients.
机译：典型的透析患者生活质量低下，生存期大大缩短。通常将其归咎于“尿毒症”。然而，定义尿毒症的临床实体非常困难。它代表了保留产物，肾脏疾病的其他影响以及其他合并症的影响的临床后遗症。可以充当尿毒症毒素的保留产物的清单很长，但似乎尿素本身对尿毒症状态没有显着贡献。分子量较大的物质可能是导致尿毒症环境的主要因素。无论原因如何，许多达到尿素清除率所定义的透析充分性指标的患者都保持尿毒症状态。这增加了更深入的血液透析可以改善患者预后的可能性。可以通过增加透析效率而不改变持续时间或频率来加强血液透析。或者，可以增加血液透析的持续时间，频率或两者。所有强化方法都会增加少量溶质的去除，但是去除较大分子量保留产物的时间更多取决于处理时间。每天短时血液透析，长时间间歇性血液透析和quotidian夜间血液透析等方法已与多种临床改善，生活质量的改善和较低的标准化死亡率相关。但是，在不对透析时间表进行重大修改的情况下，增强小溶质清除率的HEMO研究方法似乎并不有效。未来的研究将有助于确定血液透析患者的最佳治疗持续时间和频率。

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