在线血液透析滤过对终末期肾衰竭高血压患者的治疗作用

The effect of on-line hemodiafiltration on hypertension in patients with end-stage renal disease

目的探讨在线血液透析滤过(HDF)应用于单纯规律血液透析患者合并难治性高血压时的临床疗效及患者对治疗的耐受性。方法将20例终末期肾衰竭(ESRD)伴难治性高血压患者随机分为血液透析(HD)和HDF/HD两组,HD组应用标准血液透析治疗;HDF/HD组采用2次血液透析+1次血液透析滤过。两组均在联合应用降压药的基础上进行,均为4小时/次,每周3次,治疗时间为5个月。比较两组患者治疗前后血清磷、甲状旁腺素(PTH)、血浆肾素活性(PRA)及血管紧张素Ⅱ(ATⅡ)、平均动脉压、BUN及Cr的变化以及患者对治疗的耐受性。结果HDF/HD组患者血清磷、PTH、ATⅡ水平均明显下降,两组比较有显著性差异;而BUN与Cr下降的程度比较无明显差异。HDF/HD组患者极少发生头痛、恶心、呕吐、心绞痛及心律失常等并发症。结论对于尿毒症高血压患者,尤其是难治性高血压,在线血液透析滤过是一种安全、有效的治疗方法。

Objective To evaluate the clinical effect of hemodiafiltration on end-stage renal disease with hypertension and the patients＇tolerance to this treatment. Methods Ten patients with serious hypertension received hemodiafihration （HDF） during maintenance hemodialysis （HD）. Blood urea nitrogen （ Bun ）, creatinine （Cr）, phosphorus （ P）, parathyroid hormone （ PTH）, MAP, periplasmal rennin activity （PRA） and angiotonin Ⅱ （ AT Ⅱ ） were examined before and 5 months after hemodiafihration. Other ten patients received standard HD as control. Results No significantly difference was found in the clearances of Cr,Bun and PRA between HDF and HD patients;But the PTH,MAP and ATⅡ in HDF group elevated more than those ：in HD group, so compared with HD, HDF was more effective on the patients with serious hypertension during maintenance hemodialysis. Conclusion HDF is a high effective dialysis method on the ESRD patients with serious hypertension.