Objective To investigate the effect of different frequency of hemodiafiltration combined with high flux hemodialysis (HFHD) in the treatment of patients with end-stage renal (ESRD) disease. Methods A total of 108 ESRD patients treated in Fujian Provincial Hospital from January 2019 to August 2022 were retrospectively studied. They were treated with hemodiafiltration combined with HFHD, and divided according to the frequency of hemodiafiltration into low frequency group (n=36, hemodiafiltration once per month), medium frequency group (n=36, hemodiafiltration twice per month), and high frequency group (n=36, hemodiafiltration thrice per month). The treatment lasted for 6 months. The adequacy of dialysis (including Kt/V, β2-microglobulin clearance rate and urea reduction rate), residual renal function (including urine volume, residual renal Kt/V and residual renal creatinine clearance rate), nutritional status (including serum total protein, prealbumin and albumin), inflammatory factors (including interleukin-6, tumor necrosis factor-α and C-reactive protein), and complications were compared among the three groups. Results After 6 months of the treatment, the total urea clearance index (Kt/V), β2-microglobulin clearance rate, and urea reduction rate(URR) were statistically different among the three groups (F=33.410, 27.559 and 35.226 respectively; P＜0.001); residual renal function, urine volume, residual renal Kt/V, and residual renal creatinine clearance rate were different among the three groups (F=34.159, 27.911, 25.084 and 23.342 respectively;P＜0.001); serum total protein, prealbumin and albumin, interleukin-6, tumor necrosis factor-α and C-reactive protein were also different among the three groups (F=28.404, 39.842, 25.968, 41.864, 25.074 and 39.240 respectively,P＜0.001); the incidence of complications was higher in the high frequency group than in the medium frequency and low frequency groups (χ2=8.826, P=0.012). Conclusion Different frequency of hemodiafiltration combined with HFHD can improve the dialysis adequacy, residual renal function, and nutritional status in ESRD patients, with the higher frequency of hemodiafiltration being more effective. It can also reduce the expression of inflammatory factors. However, the incidence of complications remains higher.
YANG Zheng-Rong
. Effectiveness of different frequency of hemodiafiltration combined with high flux hemodialysis in the treatment of end-stage renal disease[J]. Chinese Journal of Blood Purification, 2024
, 23(04)
: 267
-271
.
DOI: 10.3969/j.issn.1671-4091.2024.04.006
[1] Rastogi A,Bhatt N,Rossetti S,et al.Management of hyperphosphatemia in end-stage renal disease: a new paradigm[J].J Ren Nutr,2021,31(1):21-34. DOI: 10.1053/j.jrn.2020.02.003.
[2] Wu PH,Lin YT,Liu JS,et al.Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis[J].Clin Kidney J,2021,14(3):983-990. DOI: 10.1093/ckj/sfaa248.
[3] Pergola PE,Rosenbaum DP,Yang Y,et al.A randomized trial of tenapanor and phosphate binders as a dual-mechanism treatment for hyperphosphatemia in patients on maintenance dialysis (AMPLIFY)[J].J Am Soc Nephrol,2021,32(6):1465-1473. DOI: 10.1681/ASN.2020101398.
[4] Blankestijn PJ,Vernooij RWM,Hockham C,et al.Effect of hemodiafiltration or hemodialysis on mortality in kidney failure[J].N Engl J Med,2023,389(8):700-709. DOI: 10.1056/NEJMoa2304820.
[5] Mitchell CR,Hornig C,Canaud B.Systematic review to compare the outcomes associated with the modalities of expanded hemodialysis (HDx) versus high-flux hemodialysis and/or hemodiafiltration (HDF) in patients with end-stage kidney disease (ESKD)[J].Semin Dial,2023,36(2):86-106. DOI: 10.1111/sdi.13130.
[6] 王岩,张爱霞,王紫晖,等.高通量血液透析与联机血液透析滤过联合治疗慢性肾衰竭疗效观察[J].新乡医学院学报,2022,39(6):573-577. DOI: 10.7683/xxyxyxb.2022.06.015.
[7] 黎磊石.中国肾脏病学.北京:人民军医出版社,2008:640-645.
[8] Takao N,Maruyama T,Kobayashi H,et al.Kinetics of glucoregulatory peptide hormones during hemodialysis with cellulose triacetate and polysulfone dialyzers in patients with diabetes and end-stage kidney disease[J].Int J Mol Sci,2023,24(13):10604. DOI: 10.3390/ijms241310604.
[9] Maduell F,Broseta JJ.Hemodiafiltration (HDF) versus expanded hemodialysis (HDx)[J].Semin Dial,2022,35(5):436-439. DOI: 10.1111/sdi.13071.
[10] Kashgary A,Khojah A,Bamalan B,et al.Effect of hemodiafiltration versus hemodialysis on cognitive function among patients with end-stage renal disease: a multicenter study[J].Cureus,2021,13(11):e19719. DOI: 10.7759/cureus.19719.
[11] Cimino C,Burnett Y,Vyas N,et al.Post-dialysis parenteral antimicrobial therapy in patients receiving intermittent high-flux hemodialysis[J].Drugs,2021,81(5):555-574. DOI: 10.1007/s40265-021-01469-2.
[12] Ma S,Pu N,Ma J.Effects of high-flux hemodialysis and hemodiafiltration on the mortality of patients with end-stage kidney disease: a meta-analysis[J].Ren Fail,2023,45(1):2147436. DOI: 10.1080/0886022X.2022.2147436.
[13] Li Y,Fu M,Yang C,et al.Effects of predilution hemodiafiltration-induced intradialytic left ventricular systolic dysfunction compared to high-flux hemodialysis[J].Int Urol Nephrol,2022,54(10):2653-2662. DOI: 10.1007/s11255-022-03177-6.
[14] 刘倩,蒲萌萌,杨凯,等.不同频率血液透析滤过联合高通量血液透析治疗尿毒症的效果分析及对预后的影响[J].中国现代医学杂志,2023,33(6):71-76. DOI: 10.3969/j.issn.1005-8982.2023.06.013.
[15] Abdelsalam M,Demerdash TM,Assem M,et al.Improvement of clinical outcomes in dialysis: No convincing superiority in dialysis efficacy using hemodiafiltration vs high-flux hemodialysis[J].Ther Apher Dial,2021,25(4):483-489. DOI: 10.1111/1744-9987.13492.
[16] Tanriover C,Ucku D,Basile C,et al.On the importance of the interplay of residual renal function with clinical outcomes in end-stage kidney disease[J].J Nephrol,2022,35(9):2191-2204. DOI: 10.1007/s40620-022-01388-9.
[17] Cupisti A,Bolasco P,D'Alessandro C,et al.Protection of residual renal function and nutritional treatment: first step strategy for reduction of uremic toxins in end-stage kidney disease patients[J].Toxins (Basel),2021,13(4):289. DOI: 10.3390/toxins13040289.
[18] Provenzano R,Shutov E,Eremeeva L,et al.Roxadustat for anemia in patients with end-stage renal disease incident to dialysis[J].Nephrol Dial Transplant,2021,36(9):1717-1730. DOI: 10.1093/ndt/gfab051.
[19] Csiky B,Sch?mig M,Esposito C,et al.Roxadustat for the maintenance treatment of anemia in patients with end-stage kidney disease on stable dialysis: a european phase 3, randomized, open-label, active-controlled Study (PYRENEES)[J].Adv Ther,2021,38(10):5361-5380. DOI: 10.1007/s12325-021-01904-6.
[20] Ridker PM,Rane M.Interleukin-6 signaling and anti-interleukin-6 therapeutics in cardiovascular disease[J].Circ Res,2021,128(11):1728-1746. DOI: 10.1161/CIRCRESAHA.121.319077.
