The cardiovascular unphysiology of thrice weekly hemodialysis.

IF 2.2 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-05 DOI:10.1097/MNH.0000000000001037

Sandipan Shringi, Ankur D Shah

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引用次数: 0

Abstract

Purpose of review: This review examines the unphysiological nature of conventional intermittent hemodialysis (IHD) and explores alternative dialysis modalities that more closely mimic natural kidney function. As cardiovascular complications remain a leading cause of morbidity and mortality in dialysis patients, understanding and addressing the limitations of IHD is crucial for improving outcomes.

Recent findings: IHD's intermittent nature leads to significant fluctuations in metabolites, electrolytes, and fluid status, contributing to hemodynamic instability and increased cardiovascular risk. More frequent dialysis modalities, such as short daily hemodialysis and nocturnal hemodialysis have numerous benefits including reduced left ventricular hypertrophy, improved blood pressure control, and potentially decreasing mortality. Peritoneal dialysis offers a more continuous approach to treatment, which may provide cardiovascular benefits through gentler fluid removal and residual kidney function preservation.

Summary: Conventional thrice weekly intermittent hemodialysis offers a fundamentally unphysiologic equilibrium of uremic solutes. Alternate approaches have demonstrated cardiovascular benefits.

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每周三次血液透析的心血管非生理学。

综述目的：本综述研究了传统间歇性血液透析（IHD）的非生理性，并探讨了更接近自然肾功能的替代透析模式。由于心血管并发症仍然是透析患者发病和死亡的主要原因，了解并解决 IHD 的局限性对于改善透析效果至关重要：IHD 的间歇性导致代谢物、电解质和体液状态的显著波动，造成血液动力学不稳定，增加了心血管风险。更频繁的透析方式，如每日短期血液透析和夜间血液透析有很多好处，包括减少左心室肥厚、改善血压控制以及降低死亡率。腹膜透析提供了一种更持续的治疗方法，可通过更温和的液体清除和残余肾功能保护为心血管带来益处。摘要：传统的每周三次间歇性血液透析提供了尿毒症溶质的基本非生理平衡。替代方法已证明对心血管有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.