不同频率血液透析滤过对维持性血液透析患者促红细胞生成素疗效的影响

目的:探讨不同频率血液透析滤过(hemodiafiltration,HDF)对维持性血液透析(maintenance hemodialysis,MHD)患者促红细胞生成素(erythropoietin,EPO)疗效的影响。方法:回顾性研究2017年06月~2019年06月杭州市中医院肾内科留治的MHD患者151例,按照在常规血液透析(hemodialysis,HD)基础上增加不同频率的HDF治疗分为HD组34例(常规HD治疗,不进行HDF治疗)、HDF1组25例(每月1次HDF)、HDF2组47例(每月2次HDF)、HDF4组45例(每月4次HDF)。所有入组患者每4周复查一次血红蛋白,根据血红蛋白水平调整EPO用量,分别于治疗前和治疗24周后测定血红蛋白、红细胞压积、超敏C反应蛋白、血清尿素氮、甲状旁腺素、干体重等指标。结果:治疗24周后,各组患者较入组时血红蛋白水平均明显上升(P均<0.05);HDF1组患者较入组时红细胞压积水平上升(P均<0.05);HDF1、HDF2、HDF4组患者较入组时ERI值、甲状旁腺素水平、超敏C反应蛋白水平下降(P均<0.05)。相关性分析显示,ERI值与铁蛋白、KT/V呈负相关关系,与甲状旁腺素、超敏C反应蛋白呈正相关关系。结论:不同频率的HDF治疗均能提高患者EPO的疗效,但提高HDF治疗的频率不能明显改善EPO疗效,就有效纠正MHD患者肾性贫血而言,可在常规HD基础上联合每月1次HDF治疗。

Effect of Different Frequency Hemodiafiltration on the Efficacy of Erythropoietin in Maintenance Hemodialysis Patients

Objective:To investigate the effect of different frequency hemodiafiltration on the efficacy of erythropoietin in maintenance hemodialysis patients.Methods:A retrospective study of 151 patients with hemodialysis patients admitted to the Department of Nephrology,Hangzhou Hospital of Traditional Chinese Medicine from June 2017 to June 2019,divided into HD group according to the different hemodiafiltration treatments based on conventional hemodialysis.No hemodiafiltration treatment was performed,25 patients in HDF1 group(1 hemodiafiltration treatment per month),47 patients in HDF2 group(2 hemodiafiltration treatments per month),and 45 patients in HDF4 group(4 times per month)Hemodiafiltration treatment.All patients were reviewed for hemoglobin every 4 weeks,and EPO dosage was adjusted according to hemoglobin level.Hemoglobin,hematocrit,hypersensitive C-reactive protein,serum urea nitrogen and other indicators were measured before treatment and 24 weeks after treatment.Results:After 24 weeks of treatment,the hemoglobin levels of the 4 groups were significantly higher than those of the group(P<0.05).The HDF1 group increased the hematocrit level(P<0.05).The HDF1,HDF2,HDF4 patients ERI values,parathyroid hormone levels,and high-sensitivity C-reactive protein levels were decreased at the time of enrollment(P<0.05).Correlation analysis showed that ERI values were negatively correlated with ferritin and KT/V,and positively correlated with parathyroid hormone and high-sensitivity C-reactive protein.Conclusion:Different frequency of HDF treatment can improve the efficacy of EPO in patients,but increasing the frequency of HDF treatment can not significantly improve the efficacy of EPO.In order to effectively correct renal anemia in patients with MHD,it can be combined with HDF treatment once a month on the basis of conventional HD.