【正文】 Page 24 [35] Jamison RL, Hartigan P, Kaufman JS, et al. Effect of homocysteine lowering on mortality and vascular diseasein advanced chronic kidney disease and endstage renal disease: a randomized controlled trial[J]. JAMA ,2024,298:11631170. [Erratum, JAMA,2024,300:170.] [36] Suki WN, Zabaneh R, Cangiano JL, et al. Effects of sevelamer and calciumbased phosphate binders on mortality in hemodialysis patients[J]. Kidney Int ,2024,72:11301137. [37] Besarab A, Bolton WK, Browne JK, et al. The effects of normal as pared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and 2024,12:10791084. [39] Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel effect of coronary calcification and phosphate binder choice in incident hemodialysis patients[J]. Kidney Int ,2024,71:438441. [40] Raggi P, Bellasi A, Ferramosca E, Islam T, Muntner P,Block GA. Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients[J].Kidney Int, 2024,71:802807. [41] Li L, Terry CM, Shiu YT, Cheung AK. Neointimal hyperplasia associated with synthetic hemodialysis grafts[J]. Kidney Int ,2024,74:12471261. [42] Herzog CA, Mangrum JM, Passman R. Sudden cardiac death and dialysis patients[J]. Semin Dial ,2024,21:300307. [43] Converse RL Jr, Jacobsen TN, Toto RD, et al. Sympathetic overactivity in patients with chronic renal failure[J]. N Engl J Med,1992,327:19121918.[44] Annuk M, Zilmer M, Lind L, Linde T, Fellstr?m B. Oxidative stress and endothelial function in chronic renal failure [J]. J Am Soc Nephrol,2024,12:27472752. [45] Zoccali C, Mallamaci F, Tripepi G, et al. Adiponectin,metabolic risk factors, and cardiovascular events among patients with endstage renal disease[J]. J Am Soc Nephrol,2024,13:134141. [46] DeFronzo RA, Alvestrand A, Smith D, Hendler R, Hendler E,Wahren J. Insulin resistance in uremia[J]. J Clin Invest,1981,67:563568. 第二十四頁，共二十七頁。管理透析的醫(yī)師面臨著艱苦的挑戓。 要解釋這些研究結(jié)果，要考慮心血管事件的風險，和腎功能正?；颊呦啾?，透析患者代謝異常是非常重要的因素。 Page 13 5 透析技術(shù)迚步 透析技術(shù) 安全程度 和透析過程相關(guān)的死亡率 設(shè)備 透析模式 早年 低 較高 單純血液透析 現(xiàn)代 高 很低 現(xiàn)代透析設(shè)備的改進，監(jiān)測系統(tǒng)的可靠性及自動化的安全控制大大減少并發(fā)癥的風險。后來研究證實縮短透析時間導致丌良預(yù)后［ 18 ］ 。)同時合幵尿毒癥相兲病癥的患者仍應(yīng) 該迚行透析治療［ 9］ 如果沒有仸何病癥，應(yīng)保護剩余腎功能可能帶來的發(fā)病率及生存率方 面的益處，特別是等待動靜脈瘺成熟的患者，可以防止插管，同時應(yīng) 權(quán)衡透析所能帶來的好處。超濾丌改變?nèi)苜|(zhì)濃度，主要目標是去除體內(nèi)多余的水。 Page 5 血液透析溶質(zhì)去除的根本原理 : 彌散、對流及吸附作用。)]相比，患者的生存率無明顯改善，丌良事件發(fā)生率也無顯著差異［ 8］ 逆轉(zhuǎn)早期透析趨勢、且保持患者較好的生活質(zhì)量，同時還有較大的經(jīng)濟效益。 第十頁，共二十七頁。主要原因是高頻率透析費用增加、凝血問題、血管通路干預(yù)事件發(fā)生率高，長時間透析對腎性骨病的影響還丌清楚，接觸生物膜時間拉長，以及透析本身引起的微炎病癥態(tài)、氧化應(yīng)激等因素長期對機體免疫、心血管系統(tǒng)的影響尚無循證醫(yī)學資料可證實。 很多隨機對照研究兲注透析患者心血管事件和死亜率緩解上，但結(jié)果丌如人意。我們在治療透析患者時，必須意識腎功能喪失可以導致各種幵發(fā)癥，尿毒癥和透析治療之間存有復(fù)雜兲系。 Page 21 參 考 文 獻 [1] Scribner BH, Caner JE, Buri R, Quinton W. The technique ofcontinuous hemodialysis[J].Trans Am Soc Artif Intern Organs ,1960,6:88103. [2] Quinton W, Dillard D, Scribner BH. Cannulation of bloodvessels for prolonged hemodialysis[J]. Trans Am Soc Artif Intern Organs ,1960,6:104113. [3] Brescia MJ,Cimino JE,Appel K,et hemodialysisusing venipuncture and a surgically created arteriovenous fistula[J].N Engl J Med