应用高通量透析器行On-line HDF有效性及安全性分析

Analysis about the efficacy and safety of on-line hemodiafiltration with high-flux hemodialyzer

目的通过与低通量血液透析(hemodialysis,HD)、高通量血液透析(high flux hemodialysis,HFHD)单次透析前后对照,来探讨应用高通量透析器行血液透析滤过(on-line hemodiafiltration,On-line HDF)治疗的安全性及有效性。方法选取2018年1月至2019年10月在石河子市人民医院透析中心维持性血液透析的尿毒症患者87例,透析患者血管通路均为前臂动静脉内瘘,每位患者均给予HD、HFHD及应用高通量血液透析器的On-line HDF三种不同血液净化方式治疗。观察记录患者一般情况性别、年龄、透析龄、透析前后平均动脉压变化,检测这三种血液净化方式单次治疗前后血清中肌酐(Scr)、尿素氮(BUN)、甲状旁腺激素(PTH)、β_(2)微球蛋白(β_(2)-MG)水平。观察并记录患者透析过程中不良反应和不良事件。结果(1)治疗前各组间血清中Scr、BUN、PTH、β_(2)-MG比较无统计学差异(P>0.05)。各组间血清中Scr、BUN下降率均大于60%,且无统计学差异(P>0.05)。(2)on-line HDF组的患者PTH下降率高于HD组、高于HFHD组[(24.11±53.44)%vs(-35.83±55.32)%vs(-27.56±66.12)%,P均<0.001]。on-line HDF组的患者β_(2)-MG下降率高于HD组、高于HFHD组[26.50%(16.75%,35.00%)vs1.00%(-1.50%,9.00%)vs20.00%(12.25%,29.75%),P均<0.001]。(3)三种血液净化方式均未发生不良反应及不良事件。结论(1)应用高通量透析器行On-line HDF治疗可有效地清除中大尿毒症毒素,效果优于HD及HFHD治疗。(2)三种透析方式均未发生不良反应和不良事件。

Objective To explore the safety and efficacy of on-line hemodiafiltration with high flux hemodialyzer compared with low flux hemodialysis and high flux hemodialysis before and after single hemodialysis.Methods 87 uremic patients undergoing maintenance hemodialysis in the dialysis center at people’s hospital of Shihezi from January 2018 to October 2019 were selected.The vascular access of the dialysis patients was forearm arteriovenous fistula.Each patient was treated with three different blood purification methods including hemodialysis(HD),high flux hemodialysis(HFHD)and on-line hemodiafiltration(on-line HDF).The gendar,age and the changes of mean arterial pressure before and after dialysis were observed and recorded.The levels of serum creatinine(Scr),urea nitrogen(BUN),parathyroid hormone(PTH)and β_(2)-microglobulin(β_(2)-MG)were measured before and after single treatment.Adverse reactions and adverse events during dialysis were observed and recorded.Results(1)There were no significant differences in serum Scr,BUN,PTH and β_(2)-MG between two groups before treatment.The decreasing rate of serum Scr and BUN in each group was more than 60%,and there was no significant difference between two groups(P>0.05).(2)The decreasing rate of PTH in on-line HDF group was higher than that in HD group and HFHD group[(24.11±53.44)%vs(-35.83±55.32)%vs(-27.56±66.12)%,P<0.001].The decreasing rate of β_(2)-MG in on-line HDF group was higher than that in HD group and HFHD group[26.50%(16.75%,35.00%)vs 1.00%(-1.50%,9.00%)vs 20.00%(12.25%,29.75%).P<0.001].(3)There were no adverse reactions and adverse events about three methods of blood purification.Conclusion(1)On-line hemodialysis with high flux dialyzer can effectively remove medium and large uremic toxins,and the effect is better than that of low flux hemodialysis and high flux hemodialysis.(2)There were no adverse reactions and adverse events in three dialysis methods.