Pre-dilution on-line haemofiltration vs low-flux haemodialysis:: a randomized prospective study
Pre-dilution on-line haemofiltration vs low-flux haemodialysis:: a randomized prospective study
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DOI：
10.1093/ndt/gfh775
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发表时间：
2005-06-01
影响因子：
6.1
通讯作者：
Kooman, JP
中科院分区：
文献类型：
--
作者：
Beerenhout, CH;Luik, AJ;Kooman, JP
背景。较大分子量尿毒症毒素分子的积累可能对透析患者的心血管和营养状态产生负面影响，并影响尿毒症症状。通过使用血液滤过（HF）方法可以提高它们的清除率。在一年的随访期间评估了低通量血液透析（HD）（超纯透析液；聚酰胺膜）和在线预稀释 HF（1:1 血液/置换比；目标滤过量：体重的 1.2 倍）对心血管和营养参数、透析间尿毒症毒素水平和生活质量（QOL；Laupacis 问卷）的影响。四十名患者被随机分组。结果。 1 年后，27 名患者符合分析条件（HF：13 名患者；HD：14 名患者）。心力衰竭患者（12 个月后为 127 +/- 33 --> 131 +/- 36 g/m(2)）或 HD 组（135 +/- 34 --> 138 +/- 32 g/m(2)）左心室质量指数没有变化。此外，脉搏波速度以及 48 小时收缩压和舒张压也没有变化。通过双能 X 射线吸收测定法评估，HF 组的去脂体重有所增加（44.8 +/- 8.9 --> 46.2 +/- 9.6 kg；P < 0.05），但 HD 组则没有增加（49.4 +/- 9.2 --> 50.6 +/- 8.8 kg），但组间差异并不显着。心力衰竭患者的胰岛素样生长因子-1 水平保持稳定，但 HD 组下降（P 5.0 +/- 1.1；P 4.4 +/- 1.4）。 β2-微球蛋白、补体因子D和同型半胱氨酸在HF组中显着降低，而在HD组中没有显着降低，而L-ADMA、瘦素和晚期糖基化终产物相关的荧光没有变化。结论。与低通量 HD 相比，预稀释在线 HF 期间未观察到心血管参数发生变化。在线心力衰竭治疗使尿毒症毒性特征发生显着变化，身体健康状况有所改善，营养状况略有改善。
Background. Accumulation of larger molecular weight uraemic toxins molecules may have a negative effect on the cardiovascular and nutritional state of dialysis patients and influence uraemic symptomatology. Their clearance can be enhanced by the use of haemofiltration (HF).Methods. The effects of low-flux haemodialysis (HD) (ultrapure dialysate; polyamide membranes) and predilution on-line HF (1: 1 blood/substitution ratio; target filtration volume: 1.2 times body weight) on cardiovascular and nutritional parameters, interdialytic levels of uraemic toxins and quality of life (QOL; Laupacis questionnaire) were assessed during ` year follow-up. Forty patients were randomized.Results. After 1 year, 27 patients were eligible for analysis (HF: 13 patients; HD: 14 patients). Left ventricular mass index did not change in the HF patients (127 +/- 33 --> 131 +/- 36 g/m(2) after 12 months) or in the HD group (135 +/- 34 --> 138 +/- 32 g/m(2)). Also, there were no changes in pulse wave velocity, and 48 h systolic and diastolic blood pressures. Lean body mass, assessed by dual-energy X-ray absorptiometry, increased in the HF group (44.8 +/- 8.9 --> 46.2 +/- 9.6 kg; P < 0.05), but not in the HD group (49.4 +/- 9.2 --> 50.6 +/- 8.8 kg), although differences between groups were not significant. Insulin-like growth factor-1 levels remained stable in the HF patients, but decreased in the HD group (P 5.0 +/- 1.1; P 4.4 +/- 1.4). beta 2-microglobulin, complement factor D and homocysteine decreased significantly in the HF but not in the HD group, whereas L-ADMA, leptin and advanced glycation end-products-related fluorescence did not change.Conclusions. No changes in cardiovascular parameters were observed during pre-dilution on-line HF compared with low-flux HD. Treatment with on-line HF resulted in marked changes in the uraemic toxicity profile, an improvement in physical well-being and a small improvement in nutritional state.