中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (04): 267-271.doi: 10.3969/j.issn.1671-4091.2024.04.006

• 临床研究 • 上一篇    下一篇

不同频率血液透析滤过联合HFHD治疗终末期肾病的效果

杨峥嵘   林 苗   曹 芳   

  1. 362200 晋江，1福建中医药大学附属晋江中医院肾病科
    350000 福州，2福建省立医院肾内科
  • 收稿日期:2023-11-07 修回日期:2024-02-01 出版日期:2024-04-12 发布日期:2024-04-12
  • 通讯作者: 杨峥嵘 E-mail:hmctk80@163.com
  • 基金资助:
    福建省2022年第二批高等教育和科研项目(闽财指[2022]840号)

Effectiveness of different frequency of hemodiafiltration combined with high flux hemodialysis in the treatment of end-stage renal disease

YANG Zheng-rong, LIN Miao, CAO Fang   

  1. Department of Nephrology, Jinjiang Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Chinese Medicine, Jinjiang 362200, China; 2Department of Nephrology, Fujian Provincial Hospital, Fuzhou 350000, China
  • Received:2023-11-07 Revised:2024-02-01 Online:2024-04-12 Published:2024-04-12
  • Contact: 362200 晋江，1福建中医药大学附属晋江中医院肾病科 E-mail:hmctk80@163.com

摘要： 目的  探讨不同频率血液透析滤过联合高通量血液透析(high flux hemodialysis，HFHD)技术治疗终末期肾病的效果。 方法  回顾性选取福建省立医院2019年1月—2022年8月108例终末期肾病患者，按照血液透析滤过频率分为3组，各36例。3组均给予HFHD，低频率组、中频率组、高频率组血液透析滤过频率分别为1次/m、2次/m、4次/m。3组均治疗6个月。比较3组透析充分性、残余肾功能(residual renal function，RRF)、营养状况、炎性因子水平及并发症发生情况。结果  治疗后6个月3组总尿素清除指数(Kt/V)、β2微球蛋白(β2-microglobulin，β2-MG)清除率、尿素氮下降率(urea reduction rate，URR)比较，差异有统计学意义(F=33.410、27.559、35.226，均P＜0.001)；治疗后6个月3组RRF、尿量、残余肾Kt/V、残余肾肌酐清除率(creatinine clearance rate，CCR)比较，差异有统计学意义(F=34.159、27.911、25.084、23.342，均P＜0.001)；治疗6个月后3组血清总蛋白、前白蛋白、白蛋白、白细胞介素-6、肿瘤坏死因子-α、C反应蛋白比较，差异有统计学意义(F=28.404、39.842、25.968、41.864、25.074、39.240，均P＜0.001)；高频率组并发症发生率高于中频率组、低频率组(χ2=8.826，P =0.012)。 结论  不同频率血液透析滤过联合HFHD技术可改善终末期肾病患者透析充分性、RRF及营养状况，其中高频率效果较优，还可降低患者炎性因子表达，但并发症发生率较高。

关键词: 血液透析滤过, 高通量血液透析, 透析充分性, 残余肾功能, 营养状况

Abstract: 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.

Key words: Hemodialysis filtration, High flux hemodialysis, Dialysis adequacy, Residual renal function, Nutritional status

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