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Том 19 №4 2017 год - Нефрология и диализ

Частота и длительность гемодиализа у пациентов с остаточной функцией почек


Асанбек к. А.

DOI: 10.28996/1680-4422-2017-4-512-521

Аннотация: Остаточная функция почек у пациентов на заместительной почечной терапии гемодиализом имеет важное значение в прогнозе выживаемости. Многочисленные исследования подтверждают связь между величиной остаточной функцией почек и улучшением качества жизни на заместительной почечной терапии как гемодиализом, так и перитонеальным диализом. Однако возникает вопрос - возможно ли снижение кратности и/или длительности процедур при относительно значимой остаточной функции почек? В большинстве руководств по гемодиализу рекомендуется корректировать диализную дозу для пациентов со скоростью клубочковой фильтрации более 2 мл/мин/1,73 м2, но точные параметры эффективного диализного времени не указываются. Наиболее изучена в этом плане модальность двухразового гемодиализа. Если в экономически развитых странах двухразовый гемодиализ применяется редко и, в основном, связан с желанием пациентов ограничить время, занятое на процедуры и транспортировку, то в ряде развивающихся стран двухразовый гемодиализ связан с экономическими ограничениями. Наблюдательные исследования, посвященные сравнению эффективности двухразового и стандартного трехразового гемодиализа у пациентов со значимой остаточной функцией почек, выявили лучшее влияние двухразового гемодиализа на такие исходы как смертность, количество госпитализаций, качество жизни в первый год лечения. Цель данного обзора - представить данные по обоснованности двухразового гемодиализа и влияние его на смертность, количество госпитализаций и качество жизни больных с остаточной функцией почек на гемодиализе, а также рассмотреть условия исследований, которые проводились по данному вопросу, и применяемость их результатов в повседневной практике.

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Ключевые слова: гемодиализ, частота сеансов, остаточная функция почек, качество жизни пациентов, смертность, количество госпитализаций, диализная доза, hemodialysis, residual renal function, health-related quality of life of patients, mortality, the number of hospitalizations, dialysis dose

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