血液透析加用on-lineHDF改善维持性血液透析患者贫血的临床观察

Effect of on-line HDF with Hemodialysis on Renal Animia in Maintenance Hemodialysis Patients

目的:观察维持性血液透析(HD)基础上加用on-line血液透析滤过(on-linehemodiafiltration,on-lineHDF)对维持性血液透析患者肾性贫血的防治作用。方法:维持性血液透析患者32例,随机分为2组,均常规使用促红细胞生成素(EPO)治疗。HD组进行常规HD治疗,每周行常规HD2次,每次5h;HD+HDF组在HD基础上加用on-lineHDF治疗,每周行1次常规HD,1次on-lineHDF,每次均治疗5h。定期测定甲状旁腺素(PTH)、白蛋白(Alb)、血红蛋白(Hb)、红细胞压积(Hct)、尿素氮(Bun)、肌酐(Scr)。结果:4月后,HD+HDF组与HD组比较,Hb、Hct、Alb明显升高,PTH明显降低,EPO维持用量明显减少,差异显著。结论:在HD基础上加用on-lineHDF可改善维持性血液透析患者的贫血,能增强EPO的疗效,减少EPO的用量,其机制与HDF能清除一些不易被CHD清除,且对红细胞生成和成熟有抑制作用的蛋白类中大分子物质,主要是PTH等有关。

Objective ：To study the effect of on-line hemodiafiltration（on-line HDF） with hemodialysis on renal anemia in maintenance hemodialysis patients and its mechanism. Methods：The study included 32 maintenance hemodialysis patients. All patients received EPO and were randomized into two groups ：conventional hemodialysis （CHD） group（n=14）,the maintenance dialysis had been done 5 hours each time twice every week;on-line HDF group（n= 18） ,all patients received one maintenance dialysis and one on-line HDF every week ,each of the maintenance dialysis and on-line HDF lasting 5 hours. All patients blood urea nitrogen（BUNt ,creatinine（Cr）,albumen （Alb） ,parathyroid hormone （PTH） and hemoglobin （Hb）,hematocrit （Her） were measured on schedule. Results： The clearance of PTH were significantly higher in HDF group than that in CHD group. The serum levels of Hb, Hct were increased but PTH,the EPO doses were decresed in HDF group while there were no significantly change in CHD group,and there were significantly diference between two groups. Conclusion ：on-line HDF can effectively improve the renal anemia in patients with maintenance hemodialysis . The possible mechanism may be related with the improved clearance of moderate and high molecular weight toxins,such as PTH.