Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration
Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration
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DOI：
10.1046/j.1523-1755.2003.00043.x
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发表时间：
2003-07-01
影响因子：
19.6
通讯作者：
Ferrero, JA
中科院分区：
文献类型：
--
作者：
Maduell, F;Navarro, V;Ferrero, JA
背景。每日透析已显示出极好的临床效果，因为较高的透析频率更符合生理需求。在线血液透析滤过（OL-HDF）是一种将扩散与高对流相结合的 HDF 技术，其中透析液本身用作回输液。本研究的目的是证明更有效的透析计划（每日透析）与提供最高尿毒症毒素清除率（在线 HDF）的透析方式的有益效果。方法。 8 名患者，6 名男性和 2 名女性，标准每周 3 次 4 至 5 小时 OL-HDF (S-OL-HDF) 改为每周 6 次每天 2 至 21/2 小时 OL-HDF (D-OL-HDF)。两个时期的透析参数相同，仅改变每次疗程的频率和透析时间。评估耐受性、尿毒症毒素清除、尿素动力学、生化和贫血特征、血压和左心室肥厚。结果。 D-OL-HDF 被广泛接受和耐受。患者很快报告透析后疲劳消失。在整个研究过程中，患者保持相同的[时间平均浓度 (TAC) 和每周单池 Kt/V (spKt/V)]。然而，D-OL-HDF 期间，等效肾尿素清除率 (EKR)、标准 KIN 和每周尿素减少率 (URR) 有所增加。 D-OL-HDF 改善了每周尿素、肌酐、骨钙素、β(2)-微球蛋白、肌红蛋白和催乳素降低率。 6 个月内，透析前血浆尿素、肌酐、酸性尿酸、β(2)-微球蛋白和同型半胱氨酸水平显着下降。减少磷酸盐结合剂并停用抗高血压药物。观察到左心室质量下降了 30%。结论。从 S-OL-HDF 到 D-OL-HDF 的变化具有良好的耐受性。观察到透析后疲劳消失、透析充分性更好、中分子和大分子去除率更高、磷酸盐结合剂减少、营养状况改善以及心血管危险因素显着减少。
Background. Daily dialysis has shown excellent clinical results because a higher frequency of dialysis is more physiologic. On-line hemodiafiltration (OL-HDF) is a HDF technique that combines diffusion with high convection in which the dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (on-line HDF).Methods. Eight patients, six males and two females, on standard 4 to 5 hours three times a week OL-HDF (S-OL-HDF) were switched to daily OL-HDF (D-OL-HDF) 2 to 21/2 hours six times per week. Dialysis parameters were identical during both periods and only frequency and dialysis time of each session were changed. Tolerance, uremic toxin removal, urea kinetics, biochemical and anemia profiles, blood pressure, and left ventricular hypertrophy were evaluated.Results. D-OL-HDF was well accepted and tolerated. The disappearance of postdialysis fatigue was rapidly reported by patients. Patients mantained the same [time average concentration (TAC) and weekly single-pool Kt/V (spKt/V)] throughout the study. However, equivalent renal urea clearance (EKR), standard KIN and weekly urea reduction ratio (URR) were increased during D-OL-HDF. Weekly urea, creatinine, osteocalcin, beta(2)-microglobulin, myoglobin, and prolactin reduction ratios were improved with D-OL-HDF. There was a significant decrease in predialysis plasma levels of urea, creatinine, acid uric, beta(2)-microglobulin and homocysteine over 6 months. Phosphate binders were reduced and antihypertensive drugs were stopped. A 30% regression of left ventricular mass was observed.Conclusion. The change from S-OL-HDF to D-OL-HDF was well tolerated. Disappearance of postdialysis fatigue, better dialysis adequacy, a higher removal of middle and large molecules, a reduction of phosphate binders, improvement of status nutritional, and an important reduction of cardiovascular risk factors were observed.