Hemodiafiltration history, technology, and clinical results
Hemodiafiltration history, technology, and clinical results
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DOI：
10.1053/j.ackd.2007.04.002
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发表时间：
2007-07-01
影响因子：
2.9
通讯作者：
Cruz, Dinna
中科院分区：
文献类型：
--
作者：
Ronco, Claudio;Cruz, Dinna
血液透析滤过(HDF)是一种使用高渗透膜的体外肾脏替代技术，其中扩散和对流可以方便地结合在一起，在较宽的相对分子质量范围内增强溶质的去除。在这种情况下，超滤超过了患者所需的液体损失，必须给予置换液以达到目标液体平衡。多年来，出现了各种HDF变种，包括无醋酸盐生物过滤、大容量HDF、内部HDF、配对过滤透析、中稀释HDF、双高通量HDF、推拉式HDF和在线HDF。最新的技术允许在线生产大量用于回输的微生物超纯液，极大地简化了HDF的实践。文献中描述了HDF相对于纯弥漫性血液透析技术的几个优点，包括更大程度地清除尿素、磷酸盐、β(2)-微球蛋白和其他较大的溶质，降低透析低血压，改善贫血管理。尽管随机对照试验未能显示HDF对生存的益处，但来自大型观察性研究的最新数据表明，HDF对生存有积极影响。本文就HDF的发展历史、各种HDF技术及其临床效果作一简要回顾。(C)2007年，由国家肾脏基金会公司提供。
Hemodiafiltration (HDF) is an extracorporeal renal-replacement technique using a highly permeable membrane, in which diffusion and convection are conveniently combined to enhance solute removal in a wide spectrum of molecular weights. In this modality, ultrafiltration exceeds the desired fluid loss in the patient, and replacement fluid must be administered to achieve the target fluid balance. Over the years, various HDF variants have emerged, including acetate-free biofiltration, high-volume HDF, internal HDF, paired-filtration dialysis, middilution HDF, double high-flux HDF, push-pull HDF, and online HDF. Recent technology has allowed online production of large volumes of microbiologically ultrapure fluid for reinfusion, greatly simplifying the practice of HDF Several advantages of HDF over purely diffusive hemodialysis techniques have been described in the literature, including a greater clearance of urea, phosphate, beta(2)-microglobulin and other larger solutes, reduction in dialysis hypotension, and improved anemia management. Although randomized controlled trials have failed to show a survival benefit of HDF, recent data from large observational studies suggest a positive effect of HDF on survival. This article provides a brief review of the history of HDF, the various HDF techniques, and summary of their clinical effects. (c) 2007 by the National Kidney Foundation, Inc.