血液透析滤过对维持性血液透析患者睡眠及生活质量影响的观察

目的观察血液透析滤过(hemodiafiltration,HDF)对维持性血液透析(maintenance hemodialysis,MHD)患者睡眠质量及生活质量的影响。方法选择MHD患者70例,分为常规血液透析治疗组(HD组)和On-line HDF治疗组(HDF组),每组各35例。HD组患者均调整为每周行3次血液透析治疗,HDF组患者每周行2次常规血液透析治疗,1次HDF,时间均为4 h。比较两组治疗前后匹兹堡睡眠质量指数量表(PSQI)、健康状况调查表(SF-36)改善情况。结果两组患者治疗后睡眠质量总评分、健康状况调查表分值较治疗前均有明显改善,其中HDF组患者入睡时间、睡眠时间、睡眠效率及PSQI总分值改善优于HD组治疗后(P0.05);肢体疼痛(BP)、总体健康(GH)、精力(VT)、情感职能(RE)及心理健康(MH)分值显著低于HD组治疗后(P0.05)。结论 HDF可更好的改善MHD患者的睡眠质量及生活质量。     

老年尿毒症患者血液透析滤过临床疗效观察

目的探讨血液透析滤过(hemodiafiltration,HDF)对老年尿毒症患者不同分子量物质的清除率、患者耐受性及临床疗效。方法选择38例行维持性血液透析(maintenance hemodialysis,MHD)的老年尿毒症患者,依经济状况随机分为HDF组和血液透析(hemodialysis,HD)组。HDF组行前稀释HDF 1次/周,HD 2次/周;HD组患者行HD 3次/周。2组HD方案一样,且观察时间均为3个月;观察2组尿素清除指数(Kt/V)、血清肌酐(SCr)、尿素氮(BUN)、血尿酸(uric acid,UA)、β2-微球蛋白(β2-microglobulin,β2-MG)、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血钾、血钙、血磷、二氧化碳结合力(carbon dioxide combining power,CO_2-CP)下降率及治疗中的并发症和不良反应发生率。结果老年尿毒症患者对HDF治疗效果和耐受性显著优于HD,HDF组的HD并发症和不适症状发生率显著低于HD组(P0.01),HDF治疗后血清β2-MG、iPTH水平显著降低,Kt/V明显增高。治疗前后2组血清BUN、SCr、UA均明显下降,但下降幅度差异无统计学意义。治疗前后2组血钾、血钙、CO_2-CP及酸碱平衡失调均明显改善或纠正(P0.01),但2组间比较其变化幅度差异无统计学意义。结论前稀释HDF、结合HD的方案与单纯HD治疗相比,能有效清除尿毒症患者血中大、中、小分子物质,透析效果显著提高。患者对该法治疗的耐受性明显提高,适用于易出现HD并发症及不适症状的老年尿毒症患者。     

不同组合透析方案对维持性血液透析患者相关并发症的影响

目的观察不同组合透析方案治疗对维持性血液透析(MHD)患者生化指标及相关并发症的疗效。方法选择泰州市人民医院血液净化中心MHD患者80例,治疗方案均为血液透析(HD)(2次/周)、血液透析滤过(HDF)(1次/周)、血液透析联合血液灌流(HD+HP)(1次/2周)的组合式透析方案。随机分为A、B两组,各40例,A组继续使用原治疗方案;B组将透析治疗方案改为HD(2次/周)、HDF(1次/周)、HDF+HP(1次/2周),观察期为3个月。记录患者入组时及治疗3个月后血压控制情况并采血检测相关指标,记录透析相关并发症等,同时统计治疗期间的费用情况。结果 A组与B组入组时各项指标比较无统计学差异(P0.05)。治疗3个月后发现:①B组收缩压、舒张压较A组明显下降,差异有统计学意义(P0.05);②与A组比较,B组甲状旁腺素、血磷、β_2微球蛋白均显著下降(P0.05),血红蛋白显著上升(P0.05),皮肤瘙痒明显改善(P0.05);③B组C-反应蛋白较A组下降,差异有统计学意义(P0.05);④A组与B组比较,血浆白蛋白水平、透析相关并发症发生率及总治疗费用无显著差异(P0.05)。结论 HD、HDF、HDF+HP组合透析方案能更好清除体内代谢产物、尿毒症毒素,纠正肾性贫血及慢性肾脏病矿物质和骨异常,改善机体内微炎症状态、营养状况及皮肤瘙痒症状,血压控制更理想。故该方案能更好的改善MHD患者远期并发症,且相对不增加治疗费用,有推广价值。     

基于铁调素调节铁代谢机制观察蚕砂提取物对血液透析患者促红细胞生成素抵抗的影响

目的通过观察维持性血液透析(maintenance hemodialysis,MHD)患者体内铁调素对铁代谢的调节作用,探讨蚕砂提取物对促红细胞生成素(erythropoietin,EPO)抵抗的干预机制。方法将40例MHD患者随机分为对照组和治疗组各20例,均给予常规透析、EPO皮下注射等治疗,在此基础上,对照组口服多糖铁复合物胶囊,治疗组口服蚕砂提取物,连续观察12周;同时选取20例健康人群作为正常组。空腹取血,采用酶联免疫吸附法(ELISA)检测铁调素、白细胞介素6(interleukin-6,IL-6),免疫比浊法检测超敏C反应蛋白(high sensitive C reactive protein,hs-CRP),化学发光法检测铁蛋白(serum ferritsn,SF)和转铁蛋白饱和度(transferin saturation,TSAT);并检测血常规(血红蛋白、红细胞压积),记录体质量(body weight,BW),计算重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)用量与EPO抵抗指数(erythropoietin resistance index,ERI)。结果与正常组比较,对照组和治疗组MHD患者的血清铁调素、IL-6、hs-CRP、SF均显著升高,TSAT显著降低(P0.05)。治疗前后比较,治疗组治疗后的血清铁调素、IL-6、hs-CRP、SF、rHuEPO用量、ERI均较治疗前有显著降低,血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit value,Hct)较治疗前有显著升高(P0.05),而对照组变化不明显(P0.05)。治疗后组间比较,治疗组的血清铁调素、IL-6、hsCRP、SF、rHuEPO用量、ERI均显著低于同期对照组,Hb、Hct均显著高于同期对照组(P0.05)。结论 MHD患者的EPO抵抗与微炎症状态、铁调素升高、铁代谢紊乱具有相关性;蚕砂提取物可以通过抑制机体的微炎症反应及铁调素高表达,改善铁代谢,这可能是蚕砂提取物纠正MHD患者贫血、改善EPO抵抗的重要机制之一。     

不同血液净化方式对维持性血液透析患者贫血治疗的影响

目的比较单纯血液透析与血液透析联合血液灌流治疗对维持性血液透析（maintenance hemodialysis,MHD）患者贫血治疗的影响。方法选择2013年4月至11月在我院血液净化中心MHD患者40例,入组前患者均每周3次行单纯血液透析治疗,并使用促红细胞生成素刺激剂（eryhropoises stimulating agent,ESA）纠正贫血。按照随机数表法将MHD患者40例分为单纯血液透析（hemodialysis,HD）治疗组（HD组）和血液透析联合血液灌流（hemoperfusion,HP）治疗组（HD＋HP组）,每组20例。HD组仍每周3次均行HD治疗;HD＋HP组每周行2次HD治疗,1次HD＋HP治疗,仍继续使用ESA;治疗12周。记录2组患者治疗前、后血红蛋白（hemoglobin,Hb）,ESA用量,计算ESA抵抗指数（ESA resistant index,ESARI）评价ESA治疗的反应,同时检测2组治疗前、后血清铁、白蛋白（albumin,Alb）、C反应蛋白（c-reactiveprotein,CRP）、全段甲状旁腺素（intact parathyroidism hormone,iPTH）水平及透析治疗的单室模型尿素清除指数（singlepool Kt／V,spKt／V）。结果40例患者均随访至第12周末。第12周时,HD＋HP组患者Hb水平较基线时显著升高[（119．27±12．16）g／L比（106．59±6．51）g／L,（P〈0．01）],而ESA剂量低于基线时水平[（76．99±16．6）IU·W^-1·kg^-l比（128．96±33．47）IU·w^-1·kg^-1（P〈0．05）],ESARI亦低于基线时水平[（0．56±0．20）比（1．30±0．47）,（P〈0．01）]。第12周时HD＋HP组患者的iPTH水平较基线时显著降低[（161．09±63．70）ng／L比（256．23±56．77）ng／L,（P〈0．01）],CRP水平较基线时降低[（4．65±1．32）mg／L比（7．55±3．23）mg／L,（P〈0．05）];而第12周时HD组患者的Hb水平、ESA用量、ES—ARI值及iPTH、CRP水平与基线时比较无统计学差异（P〉0．05）。结论HD联合HP治疗较单纯HD治疗能更有效清除CRP、iPTH,提高MHD患者对ESA治疗的反应性,减少ESA使用剂量,改善MHD患者纠正贫血治疗的效果。     

不同血液净化方式对维持性血液透析患者矿物质及骨代谢异常的治疗效果

目的探讨3种血液净化方式联合骨化三醇注射液治疗尿毒症血液透析患者矿物质及骨代谢异常的差异。方法 60例维持性血液透析(MHD)患者,随机分为血液透析(HD)组、血液透析滤过(HDF)组、血液透析+血液灌流(HD+HP)组,每组患者20例,所有患者均使用骨化三醇注射液治疗,测定入选时及随访1个月和6个月后血钙、血磷、血甲状旁腺素(iPTH)。结果治疗前3组患者血清钙、磷、iPTH水平差异无统计学意义(P0.05)。治疗1个月及6个月后,患者血钙、血磷水平,3组间两两比较差异无统计学意义(P0.05)。3组患者血iPTH下降。HD组iPTH水平治疗1个月与治疗前比较差异无统计学意义(P0.05);治疗6个月与治疗前及治疗1个月比较,差异有统计学意义(P0.05)。HDF组和HD+HP组iPTH水平治疗1个月、6个月与治疗前比较明显下降,差异有统计学意义(P0.05)。HD+HP组iPTH水平治疗6个月和治疗1个月比较,差异有统计学意义(P0.05)。治疗6个月时,iPTH水平HD+HP组与HD组、HDF组比较,差异有统计学意义(P0.05)。结论对并发矿物质及骨代谢异常的维持性血液透析患者而言,血液透析滤过及血液透析+血液灌流联合骨化三醇注射液治疗更可有效控制矿物质及骨代谢异常,血液透析+血液灌流可以显著降低血iPTH和改善患者临床症状。     

On-line血液透析滤过对维持性血液透析患者矿物质代谢的影响

目的 探讨On-line血液透析滤过技术对维持性血液透析患者矿物质代谢的影响.方法 选取尿毒症维持性血液透析患者110例,采用数字表法随机分为常规血液透析治疗组(HD组)和On-line血液透析滤过治疗组(HDF组),每组各55例.HD组患者每周行3次血液透析治疗,HDF组患者每周行2次常规血液透析治疗,1次血液透析滤过,时间均为4h.监测治疗当天和治疗3个月后患者外周血中血清钙离子、磷、全段甲状旁腺激素(iPTH)及碱性磷酸酶(ALP)等矿物质代谢的评估指标.结果 治疗前两组患者血钙、磷、iPTH及ALP水平差异无统计学意义(均P＞0.05).治疗3个月后,HD组血钙、iPTH和ALP与治疗前比较差异无统计学意义(均P＞0.05),血磷低于治疗前水平,与治疗前比较差异有统计学意义(P＜0.05).HDP组治疗后血磷、iPTH和ALP较治疗前下降明显(均P＜0.01).治疗后,HDF组血磷和ALP较HD组显著降低,差异有统计学意义(P＜0.05),iPTH降低更为显著(P＜0.01).结论 与普通血液透析比较,On-line血液透析滤过治疗能有效清除血磷,降低iPTH和ALP水平,从而改善维持性血液透析患者的矿物质代谢异常.     

碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常患者钙磷代谢的影响

目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P0.05);3组血磷及钙磷乘积较治疗前明显下降(P0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P0.05)。HD组门H在治疗前、后变化不大(P0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。     

夜间血液透析改善血液透析患者贫血治疗

目的比较夜间血液透析(nocturnal hemodialysis,NHD)相对于传统血液透析(conventional hemodialysis,CHD)对血液透析患者贫血治疗的影响。方法收集自2009年2月至2017年12月在海军军医大学附属长征医院透析的26例NHD患者,其中21例由CHD更改为NHD,匹配患者性别、年龄、初始血红蛋白水平等标准,按照时间先后顺序选出60例CHD患者作为对照组,比较两组透析患者的一般情况、铁蛋白、转铁蛋白饱和度、C反应蛋白(C-reactive protein,CRP)等指标及透析间促红细胞生成素(erythropoieth,EPO)用量、铁剂用量、输血事件发生率等差异。结果 NHD与CHD组在入选时基线状态的CRP、铁蛋白与转铁蛋白饱和度均无显著差异(P0.05),NHD组随访末次的EPO用量低于CHD组(103.4±53.6 IU·kg~(-1)·w~(-1)vs 126.34±54.9 IU·kg~(-1)·w~(-1),P0.05),NHD组随访末次的血红蛋白高于CHD组,且NHD组静脉铁剂使用率低于CHD组,两组间CRP、铁蛋白、转铁蛋白饱和度无显著性差异。更换透析模式治疗的21例患者,随访末次血红蛋白水平高于基线值血红蛋白水平(P0.05),铁蛋白、转铁蛋白饱和度、CRP无显著性差异(P0.05),平均EPO用量与更换模式治疗前1年比较未见明显差异(106±34.6 IU·kg~(-1)·w~(-1)vs 110±30.9 IU·kg~(-1)·w~(-1))。结论夜间透析与传统血液透析相比,减少患者EPO及静脉铁剂的剂量,对透析患者的贫血控制效果更加完善。     

不同血液净化方式对维持性血透患者尿毒素清除效果的观察

目的:观察不同血液净化方式对维持性血透(maintenance hemodialysis,MHD)患者尿毒素清除的效果。方法:选择我院血液净化中心符合入选标准的60例MHD患者,随机分为血液灌流联合血液透析(HP+HD)组,血液透析滤过(HDF)组,血液透析(HD)组,各组均为20例。于单次治疗前后分别测定血清尿素氮(BUN)、β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)。应用Daugirdas公式计算单次透析充分性(KT/V)。记录患者治疗中出现的与治疗相关的不良反应。结果:(1)各组患者治疗后血清BUN水平均显著下降(P<0.01),KT/V均超过1.3,但各组间BUN下降率及KT/V差异无统计学意义。(2)β2-MG水平在HDF组显著下降(下降率66.23%),但在HD组及HP+HD组其治疗后水平反而较治疗前有所增加,但差异无统计学意义(P>0.05),尤其在HD组增加更为明显(-16.26%VS-0.83%,P<0.05)。(3)HDF及HP+HD均能显著降低血清PTH水平(P<0.01),但两组间差异无统计学意义(下降率55.94%VS51.76%,P>0.05)。HD组治疗前后PTH水平无明显变化。(4)HDF、HP+HD及HD均能显著降低血清Hcy水平(P<0.01),但各组间差异无统计学意义。(5)各组治疗后血清hs-CRP水平均较治疗前有所增加,但差异无统计学意义(P>0.05)。各组间hs-CRP增加率也差异无统计学意义。(6)各组患者均顺利完成治疗,未见明显不良反应。结论:以活性炭为吸附剂的血液灌流联合血液透析能够有效清除尿毒症小、中分子毒素(BUN、PTH)及蛋白结合毒素(Hcy),对β2-MG的清除优于常规血液透析,但次于血液透析滤过。单次透析充分性好。无明显不良反应。     

两种不同血液净化方式对血清钙磷和甲状旁腺激素清除的对比研究

目的 探讨血液灌流串联血液透析与血液透析滤过对尿毒症患者血清中钙、磷、甲状旁腺激素清除的效果.方法 选择长期维持并规律性进行血液透析的尿毒症患者40例,按随机数字表法分为血液灌流串联血液透析组(20例),每2周常规血液透析治疗5次,血液灌流串联血液透析治疗1次;血液透析滤过组(20例),每2周常规血液透析治疗5次,血液透析滤过治疗1次.两组疗程均为12周.分别记录首次透析前、后及治疗4、12周时患者血清钙、磷、甲状旁腺激素值,并对两组进行比较.结果 两组均可使血清钙、磷、甲状旁腺激素值下降.首次治疗清除效果均显著(P<0.01);治疗4、12周时,血清钙、磷的下降不及甲状旁腺激素下降明显,但血液灌流串联血液透析组较血液透析滤过组清除血清钙、磷明显(P<0.05),清除甲状旁腺激素更明显,且差异有统计学意义(P<0.01).结论 血液灌流串联血液透析能有效地清除尿毒症患者血清中的钙、磷和甲状旁腺激素,且优于血液透析滤过,有临床推广价值.     

高通量血液透析与常规血液透析联合血液透析滤过的临床疗效比较

目的比较高通量血液透析（HFHD）与常规血液透析（HD）联合血液透析滤过（HDF）治疗尿毒症患者的有效性和安全性。方法选择维持性血液透析（MHD）患者55例,分为治疗组（高通量血液透析,3次／周）29例;对照组（低通量血液透析2次／周＋血液透析滤过1次／周）26例,随访6个月,进入试验前1周内（基线期）及开始治疗后3、6个月测定周中透析前血常规、肝肾功能、电解质、全段甲状旁腺激素（iPTH）、132微球蛋白（132一MG）、C反应蛋白（CRP）,记录每次透析透前、透后血压。结果2组血常规、白蛋白、CRP、电解质、VI＇H、血脂等指标各时期的组内及组间均无统计学差异（P〉（）．05）。各时期每次透析前、后收缩压（SE｜P）、舒张压（I）J妒）的组间比较无统计学差异（P〉O．05）。治疗组自开始治疗后第1月起至第6月透析前SBP较基线期显著下降（P〈f）．05）。2组各个时期血清胆一MG及血磷比较无显著差异,但治疗组第6个月的血磷值显著低于基线期（P〈0．01）。结论两种透析方式长期疗效可能是相当的,HFHD组血压的控制及血磷的清除更好,可能更有临床推广的潜力。     

超纯透析液对血液透析患者促红素低反应性的影响

目的 探讨超纯透析液对维持性血液透析患者促红细胞生成素低反应性的影响.方法 选择维持性血液透析患者70例,随机分为普通透析液组(CD组,35例)和超纯透析液组(UPD组,35例),随访1年后观察两组超敏C反应蛋白(hs-CRP)和促红细胞生成素抵抗指数(Erythropoietin resistance index,ERI)的差异.结果 ①以ERI为因变量进行多元逐步线性回归分析,显示hs-CRP是ERI最为重要的独立影响因素(R2=0.699,p＜0.001);②随访1年后两组间hs-CRP差异有统计学意义(5.12±2.74 vs 3.77±2.19,P＜0.05),超纯透析液组ERI有明显改善(11.06±5.27 vs 16.42±7.05,p＜0.01).结论 ①C-反应蛋白升高是促红细胞生成素抵抗的独立影响因素;②使用超纯透析液可改善患者炎症状态和促红素低反应性.     

不同血液净化方式对尿毒症皮肤瘙痒的疗效观察

目的探讨不同血液净化方式对尿毒症皮肤瘙痒的治疗效果。方法选择70例尿毒症规律性血液透析伴皮肤瘙痒患者,分为血液灌流串联血液透析（HP／HD组）、血液透析滤过（HDF组）、高通量透析（HFD组）、普通血液透析（HD组）进行治疗。观察皮肤瘙痒等临床症状缓解情况及血清甲状旁腺素等指标变化。结果HP／HD组、HDF组、HFD组治疗前后,血清PTH水平下降,皮肤瘙痒明显缓解;与HD组比较差异有统计学意义（P〈0．01或P〈0．05）。结论血液灌流串联血液透析和血液透析滤过、高通量透析较普通血液透析能更有效的清除PTH,可有效缓解皮肤瘙痒等症状。     

血液透析联合血液透析滤过对糖尿病肾病维持性血液透析患者的心脏结构及功能影响

目的：探讨血液透析联合血液透析滤过对糖尿病肾病MHD患者心脏结构及功能的影响.方法：选择上海市第六人民医院血液透析中心接受规律血液透析3年以上的糖尿病肾病MHD患者47例,分为单纯HD组17例,常规血液透析3次/周;HD＋HDF组30例,常规血液透析2次/周,血液透析滤过1次/周.并收集临床一般资料和生化指标.所有患者在治疗前及治疗3年后均行心脏彩超检查测定左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）、左心房内径（LAD）、左心室后壁厚度（LVPWT）、室间隔厚度（IVST）、左心室射血分数（LVEF）、二尖瓣前向血流E峰与A峰比值（E/A）,根据Devereux公式计算左心室心肌质量指数（LVMI）.结果：（1）比较治疗前后P3-、Ca2＋＆#215;P3-、hs-CRP及Pro-BNP发现,治疗后显著高于治疗前,且与心脏结构和功能密切相关,尤其是与LVMI呈正相关,与LVEF呈负相关,同时与LVEDd、LVEDs、LAD、LVPWT、IVST及E/A存在相关.（2）与同组治疗前比较,HD＋HDF组P3-、Ca2＋＆#215;P3-、Hs-CRP及Pro-BNP均显著低于治疗前,而单纯HD组与之相反,差异均有统计学意义;同时还发现,HD＋HDF组LVMI较治疗前下降,LVEF较治疗前升高,差异有统计学意义,而HD组LVMI及LVEF治疗前后均没有变化,差异无统计学意义.（3）两组治疗后比较发现,HD＋HDF组P3-、Ca2＋＆#215;P3-、Hs-CRP及Pro-BNP均显著低于单纯HD组,差异均有统计学意义;HD＋HDF组LVEDd及LVMI显著低于单纯HD组,而LVEF显著高于单纯HD组,差异也有统计学意义.结论：血液透析联合血液透析滤过能有效改善糖尿病肾病MHD患者的左心室肥大及心功能,这可能与血液透析滤过能更好的纠正钙磷代谢紊乱、减轻炎症反应及降低Pro-BNP有关.     

Clinical improvement by increased frequency of on-line hemodialfiltration.

BACKGROUND/AIMS: In spite of the better efficiency of on-line hemodiafiltration (HDF) compared with conventional hemodialysis (HD), it is relatively expensive. The aim of this study was to assess the advantages in the biochemical, hemodynamic and clinical effects in uremic patients treated with on-line HDF and with different frequencies of combination high-flux HD. METHODS: One hundred eleven patients were divided into four groups receiving different frequencies of on-line HDF (thrice, twice, once per week) and high-flux HD. RESULTS: Hemodynamic parameters including maximum drop of systolic blood pressure, episodes of symptomatic hypotension and mean saline infusion volumes during dialysis were reduced when frequencies of on-line HDF were increased. Significant improvements in urea kinetic were observed when frequencies of on-line HDF were increased. On-line HDF significantly reduced the amount of erythropoietin needed and improved intra- and inter-dialysis symptoms, physical well-being, menstruation and skin pigmentation when frequency of HDF is increased to three time per week. CONCLUSION: On-line HDF offers a better cardiovascular stability and clinical improvement. Thrice weekly on-line HDF offers a significant benefit when compared with lower frequencies of HDF per week and high-flux HD.     

Variation of clinical and laboratory features in chronic dialysis patients treated with high-flux hemodialysis after switching to online hemodiafiltration

Purpose

The study of online hemodiafiltration (HDF) benefits over high-flux hemodialysis (HD) raises great interest. The purpose was to compare clinical and laboratory parameters in patients treated with HD who were switched to HDF.

Methods

Forty-eight HD patients (study group) were switched to HDF, while other 521 patients remained on HD as a control group. During last 6 HD months and during first year of HDF, we determined in both groups the following parameters: monthly–weekly dialysis time, systolic and diastolic blood pressure, body mass index (BMI), interdialytic body weight gain (IBWG), blood flow rate (Qb), weekly erythropoietin-stimulating agents dose (EPO), single-pool Kt/V, calcium, phosphorus (P), hemoglobin and normalized protein catabolic ration (nPCR), plus every 3 months—albumin, parathormone (PTH), ferritin and transferrin saturation (TSAT). In both groups, parameters in the last 6 HD months were compared to those in the first 6 months and, respectively, to those in the first year of HDF.

Results

In the study group, albumin and nPCR were significantly higher in the HD period not only compared to the first 6 months of HDF, but also compared to the first year of HDF. IBWG and P were higher with HD compared to the first year of HDF, but not with the first 6 months. PTH, Kt/V, Qb and EPO were higher in both HDF periods. In the control group, albumin was significantly higher in the first 6 months after the switch, but it was significantly lower in the first year. BMI, ferritin, PTH, Kt/V, Qb, TSAT and weekly dialysis time were higher in both HDF periods, while nPCR, EPO, SBP and DBP were lower. IBWG and Hb rose only during the first year after the switch, while P was lower in the first year, but not in the first 6 months.

Conclusions

Nutrition, assessed by albumin, nPCR and BMI, was not improved by HDF compared to HD. With HDF, Kt/V and phosphorus control were better, similar results were observed in the control group. A larger EPO dose was needed with HDF for maintaining a similar hemoglobin level.     

不同血液净化方式对清除晚期氧化蛋白产物的效果及对心血管预后的影响

目的观察尿毒症患者血清晚期氧化蛋白产物水平,对比不同血液净化方式对其清除效果,探讨其与心血管疾病的关系。方法将60例维持性血液透析患者随机分为单纯血液透析（HD）组、血液透析联合血液透析滤过（HD＋HDF）组和血液透析联合血液灌流（HD＋HP）组,每组20例;另设健康对照及尿毒症未透析组,观察12个月。结果尿毒症未透析组血清晚期氧化蛋白产物明显高于健康对照组（P〈0．01）,透析后进一步升高（P〈0．05）;12个月后,HD＋HDF组及HD＋HP组血清晚期氧化蛋白产物水平及心血管并发症发生率低于HD组（P〈0．05）。结论①尿毒症患者HD后血清晚期氧化蛋白产物水平升高;②HD＋HDF或HD＋HP血液灌流能降低尿毒症患者血清晚期氧化蛋白产物水平,改善维持性血液透析患者心血管预后。     

Factors related to erythropoietin hypo-responsiveness in patients on chronic peritoneal dialysis

Background The present study was aimed at investigating the factors related to hypo-responsiveness to erythropoietin in patients on chronic peritoneal dialysis (PD). Methods We studied 44 patients with end-stage renal disease who had been on PD for more than 6 months and on erythropoietin (EPO) ≥6,000 U/week for more than 3 months. We expressed EPO resistance index (ERI) as weekly EPO dose per hematocrit (Hct) per body weight. The dose of EPO was titrated to maintain a target Hct level between 33% and 36%. Patients were divided into two groups according to weekly EPO dose. We compared the various factors in those two groups and, by using correlation and linear regression analysis, investigated factors that might predict EPO resistance. Results There were 13 patients in the EPO <150 U/kg per week group and 31 patients in the EPO ≥150 U/kg per week group. Among those 31 patients, there were five patients on EPO ≥300 U/kg per week. Compared to the EPO <150 U/kg per week group, the EPO ≥150 U/kg per week group had a lower normalized protein catabolic rate (nPCR), lower level of serum albumin and higher C-reactive protein (CRP). Correlation analysis showed that the ERI had a statistically significant correlation with CRP (r = 0.303, P < 0.05), serum albumin (r = −0.26, P < 0.05), parathyroid hormone (PTH) (r = −0.307, P < 0.05) and nPCR (r = −0.259, P < 0.05). These results show that CRP, serum albumin, PTH and nPCR are factors related to hypo-responsiveness. Multiple stepwise linear regression analysis showed that CRP was the most important independent predictor of EPO hypo-responsiveness. Conclusion CRP, serum albumin, nPCR and PTH are factors related to hypo-responsiveness. Inflammation contributes significantly to EPO hypo-responsiveness.     

Recombinant human erythropoietin dosage in children undergoing hemodialysis and continuous ambulatory peritoneal dialysis

The efficacy of erythropoietin (EPO) in 11 children on hemodialysis (HD) and 8 on continuous ambulatory peritoneal dialysis (CAPD) (mean age 11.8 years) was compared. The initial EPO dose was 50 U/kg s.c. once a week; the time of observation was 24 weeks. In the CAPD group, the mean hemoglobin (Hb) level increased from 7.7±0.2 to 11.2±0.6 g/dl (P< 0.001) and hematocrit (Hct) from 22.3±1.0 to 32.6±1.4% (P<0.001), while in the HD group the mean Hb rose from 7.7±0.6 to 9.3±0.8 g/dl (P<0.001) and mean Hct from 22.7±2.3 to 27.6±2.8% (P<0.001) after 12 weeks of observation. An increase in Hb to over 10 g/dl was obtained in 87.5% of children on CAPD but in only 10% on HD after 8 weeks of EPO treatment. After 12 weeks of treatment, all children on CAPD had the target Hb level of more than 10 g/dl, while 7 children on HD required increased doses of EPO (100 U/kg per week). We conclude that the EPO dose of 50 U/kg given s.c. once a week is effective for children with anemia on CAPD but is insufficient for children on HD. Received June 17, 1996; received in revised form January 24, 1997; accepted March 4, 1997