Prospective randomized cross-over long-term comparison of online haemodiafiltration and ultrapure high-flux haemodialysis.
Prospective randomized cross-over long-term comparison of online haemodiafiltration and ultrapure high-flux haemodialysis.
复制标题
在线血液透析滤过和超纯高通量血液透析的前瞻性随机交叉长期比较。
DOI：
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发表时间：
2007
影响因子：
4.2
通讯作者：
H. Schiffl
中科院分区：
文献类型：
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作者：
H. Schiffl
背景
未通过扩散充分清除的残留尿毒症综合征被认为是导致维持性透析患者预后不良的原因。血液透析滤过将扩散和对流结合在单一疗法中，理论上比血液透析具有优势。然而，仅进行了很少的随机比较。
方法
高通量超纯血液透析和在线血液透析滤过的前瞻性交叉临床评估包括 76 名接受低通量传统碳酸氢盐缓冲血液透析的临床稳定患者。他们被随机接受高通量血液透析或在线血液透析滤过（24 个月），然后改用替代治疗（24 个月）。
结果
在线血液透析滤过的尿素 (Kt/V) 和磷酸盐去除率明显高于血液透析。高通量血液透析和血液透析滤过均与治疗前 β2 微球蛋白水平持续降低相关，但血液透析滤过降低幅度更大。两种肾脏替代治疗模式均显着改善营养状况和对 rHu EPO 的造血反应。在不匹配的条件下（钠和能量平衡），血液透析滤过与低血压发作次数的减少和生活质量的部分改善相关。两组的死亡发生率都很低，并且两种肾脏替代治疗模式之间没有差异。
结论
即使从长远来看，在线血液透析滤过对于终末期肾病患者来说也是一种安全、有效且耐受性良好的治疗方法。在线血液透析滤过是否可以改变未经选择的终末期肾病患者的惨淡死亡率仍有待大规模长期试验的证明。
BACKGROUND
The residual uraemic syndrome that is inadequately cleared by diffusion is thought to contribute to the poor outcome of maintenance dialysis patients. Haemodiafiltration combines diffusion and convection in a single therapy, conferring theoretical benefits over haemodialysis. However, only few randomised comparisons have been carried out.
METHODS
The prospective crossover clinical evaluation of high-flux ultrapure haemodialysis and online haemodiafiltration included 76 clinically stable patients on low-flux conventional bicarbonate buffered haemodialysis. They were randomized to high-flux haemodialysis or online haemodiafiltration (24 months) and switched to the alternative treatment (24 months).
RESULTS
Removal of urea (Kt/V) and phosphate was significantly greater for online haemodiafiltration than for haemodialysis. Both high-flux haemodialysis and haemodiafiltration were associated with sustained reductions of pretreatment beta 2 microglobulin levels, however, the decrease was greater with haemodiafiltration. Both modes of renal replacement therapy significantly improved nutritional status and the haematopoietic response to rHu EPO. Under unmatched conditions (sodium and energy balance) haemodiafiltration was associated with a lower number of hypotensive episodes and partial improvement of quality of life. The incidence of death was low in both groups and did not differ among the two modes of renal replacement therapy.
CONCLUSION
Online haemodiafiltration is a safe, effective and well tolerated therapy for end-stage renal disease patients even in the long run. Whether the dismal mortality rates of unselected end-stage renal disease patients can be changed by online haemodiafiltration remains to be shown in large scale long-term trials.