血液透析滤过的技术及应用现状

doi:10.3969/j.issn.1671-4091.2021.10.001

摘要/Abstract

摘要： 【摘要】血液透析滤过逐渐成为一种常见的肾脏替代治疗方式。血液透析滤过在一次透析中，溶质的清除方式同时包含了弥散和对流，可以同时实现小分子和中大分子量毒素的有效清除。来自中国和国际的近期报告显示，使用在线透析滤过治疗的患者总数逐渐增加。从目前的研究和临床应用情况，亚太地区的临床经验和实践模式与欧洲有所不同，需要根据实际情况进行具体分析。本文综述了血液透析滤过的技术要求和临床研究及应用的现状。

关键词: 血液透析滤过, 血液透析, 终末期肾病, 肾脏替代治疗

Abstract: 【Abstract】Hemodiafiltration has gradually become a common renal replacement therapy. The solute removal method in the hemodiafiltration process includes both diffusion and convection, which can simultaneously achieve the effective removal of small molecules and medium and large molecular weight toxins. Recent reports from China and international researches show that the total number of patients using online hemodiafiltration therapy is gradually increasing. According to the current research and clinical application situation, the clinical experience and practice mode in the Asia-Pacific region are different from those in Europe,
and specific studies are needed to be carried out according to the actual situation. In this paper, we reviewed the technical requirements, clinical researches and application status of hemodiafiltration in this article.

Key words: Hemodiafiltration, Hemodialysis, End-stage renal disease, Renal replacement therapy

中图分类号:

R459.5

陈育青, Bernard Canaud. 血液透析滤过的技术及应用现状[J]. 中国血液净化, 2021, 20(10): 649-653.

参考文献

1. Farrell PC, Babb AL. Estimation of the permeability of cellulosic membranes from solute dimensions and diffusivities[J]. J Biomed Mater Res, 1973,7(4):275-300.
2. Tattersall JE, Ward RA, group E. Online haemodiafiltration: definition, dose quantification and safety revisited[J]. Nephrol Dial Transplant, 2013,28(3):542-50.
3. Ward RA, Schmidt B, Hullin J, Hillebrand GF, Samtleben W. A comparison of on-line hemodiafiltration and high-flux hemodialysis: a prospective clinical study[J]. J Am Soc Nephrol, 2000,11(12):2344-50.
4. Maduell F, Navarro V, Cruz MC, Torregrosa E, Garcia D, Simon V, et al. Osteocalcin and myoglobin removal in on-line hemodiafiltration versus low- and high-flux hemodialysis[J]. Am J Kidney Dis, 2002,40(3):582-9.
5. Donauer J, Schweiger C, Rumberger B, Krumme B, Bohler J. Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis[J]. Nephrol Dial Transplant, 2003,18(8):1616-22.
6. Locatelli F, Marcelli D, Conte F, Limido A, Malberti F, Spotti D. Comparison of mortality in ESRD patients on convective and diffusive extracorporeal treatments. The Registro Lombardo Dialisi E Trapianto[J]. Kidney Int, 1999,55(1):286-93.
7. Nakai S, Iseki K, Tabei K, Kubo K, Masakane I, Fushimi K, et al. Outcomes of hemodiafiltration based on Japanese dialysis patient registry[J]. Am J Kidney Dis, 2001,38(4 Suppl 1):S212-6.
8. Ohtake T, Oka M, Ishioka K, Honda K, Mochida Y, Maesato K, et al. Cardiovascular protective effects of on-line hemodiafiltration: comparison with conventional hemodialysis[J]. Ther Apher Dial, 2012,16(2):181-8.
9. Sichart JM, Moeller S. Utilization of hemodiafiltration as treatment modality in renal replacement therapy for end-stage renal disease patients--a global perspective[J]. Contrib Nephrol, 2011,175:163-9.
10. Akizawa T, Koiwa F. Clinical Expectation of Online Hemodiafiltration: A Japanese Perspective[J]. Blood Purif, 2015,40 (Suppl 1):12-6.
11. Xie F, Zhang D, Wu J, Zhang Y, Yang Q, Sun X, et al. Design and implementation of the first nationwide, web-based Chinese Renal Data System (CNRDS) [J]. BMC Med Inform Decis Mak, 2012,12:11.
12. Canaud B, Kohler K, Sichart JM, Moller S. Global prevalent use, trends and practices in haemodiafiltration[J]. Nephrol Dial Transplant, 2019.
13. Zhang W, Mei C, Chen N, Ding X, Ni Z, Hao C, et al. Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study[J]. BMC Nephrol, 2019,20(1):34.
14. Li X, Li M, Liu T, Li L, Duan L, Li Y, et al. Hemofiltration or hemodiafiltration with on-line production of substitution fluid: clinical observation of safety and effectiveness[J]. Chin Med J (Engl),1997,110(7):520-5.
15. Lin CL, Huang CC, Chang CT, Wu MS, Hung CC, Chien CC, et al. Clinical improvement by increased frequency of on-line hemodialfiltration[J]. Ren Fail,2001,23(2):193-206.
16. Weng CJ, Chang MY, Chen YC, Tian YC, Fang JT, Yang CW. Long-term online hemodiafiltration does not reduce the frequency and severity of acquired cystic kidney disease in hemodialysis patients[J]. Ren Fail,2009,31(7):555-61.
17. Zhang DL, Liu J, Liu S, Zhang Y, Liu WH. The differences of asymmetric dimethylarginine removal by different dialysis treatments[J]. Ren Fail,2010,32(8):935-40.
18. Rong S YC, Ma Y, Chen J, Zhang B, Ji Y, et al. . Comparison of efficacy and safety of high-flux hemodialysis and conventional hemodialysis combining hemodiafiltration[J]. J Clinical Nephrology, 2013,13(2):4.
19. Xu B CL, CY HDL, Ling Y, Guan T. Effects of different blood purification methods on the removal of advanced oxidized protein products and the impact on cardiovascular prognosis[J]. J Clin Nephrol,2013,13(2):4.
20. Peng B XT, Wang N, Sheng X. Impact of hemodialysis combined with hemodiafiltraton on cardiac structure and function in maintenance hemodialysis pateints with diabetic nephrology[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2014,15(2):5.
21. Cai J-W. Effects of different hemodialysis methods on serum pathogenicfactors in patients with renal failure[J]. Zhejiang Journal of Clinical Medicine. 2015;17(5):2.
22. Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R. Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis[J]. Am J Kidney Dis,2015,66(2):322-30.
23. Davenport A, Peters SA, Bots ML, Canaud B, Grooteman MP, Asci G, et al. Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: the effect of adjustment for body size[J]. Kidney Int, 2016,89(1):193-9.
24. Peters SA, Bots ML, Canaud B, Davenport A, Grooteman MP, Kircelli F, et al. Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials[J]. Nephrol Dial Transplant, 2016,31(6):978-84.
25. Nube MJ, Peters SAE, Blankestijn PJ, Canaud B, Davenport A, Grooteman MPC, et al. Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis[J]. Nephrol Dial Transplant, 2017,32(3):548-55.
26. IOF S. Quality of Dialysis Fluid for Haemodialysis andRelated Therapies (ISO11663: 2014) [J]. Geneva, Switzerland, International Organization for Standardization, 2014. 2014.
27. Ward RA, Vienken J, Silverstein DM, Ash S, Canaud B, Kidney Health Initiative HDFW. Regulatory Considerations for Hemodiafiltration in the United States[J]. Clin J Am Soc Nephrol,2018,13(9):1444-9.
28. IOF. S. Guidance for the Preparation and Quality Management of Fluids for Haemodialysis and Related Therapies (ISO 23500:2014) [J]. Geneva, Switzerland, International Organization for Standardization, 2014.
29. Schmitz M, Loke O, Fach B, Kalb K, Heering PJ, Meinke D, et al. Effects of citrate dialysate in chronic dialysis: a multicentre randomized crossover study[J]. Nephrol Dial Transplant, 2016,31(8):1327-34.
30. Dhondt A, Pauwels R, Devreese K, Eloot S, Glorieux G, Vanholder R. Where and When To Inject Low Molecular Weight Heparin in Hemodiafiltration? A Cross Over Randomised Trial[J]. PLoS One, 2015,10(6):e0128634.
31. Tiranathanagul K, Praditpornsilpa K, Katavetin P, Srisawat N, Townamchai N, Susantitaphong P, et al. On-line hemodiafiltration in Southeast Asia: a three-year prospective study of a single center[J]. Ther Apher Dial, 2009,13(1):56-62.
32. Yamashita AC, Sato T. Central online hemodiafiltration in Japan: management of water quality and practice[J]. Blood Purif, 2009,27 Suppl 1:50-5.
33. Tiranathanagul K, Susantitaphong P, Keomany C, Mahatanan N, Praditpornsilpa K, Eiam-Ong S. Long-term efficacy of pre- and post-dilution online hemodiafiltration with dialyzer reuse[J]. J Med Assoc Thai, 2012,95(5):650-6.
34. Tiranathanagul K, Tangvoraphonkchai K, Srisawat N, Susantitaphong P, Tungsanga K, Praditpornsilpa K, et al. Acute intradialytic cardiac function and inflammatory cytokine changes during high-efficiency online hemodiafiltration with acetate-free and standard dialysis solutions[J]. Ther Apher Dial, 2015,19(3):250-8.
35. Watanabe Y, Kawanishi H, Suzuki K, Nakai S, Tsuchida K, Tabei K, et al. Japanese society for dialysis therapy clinical guideline for "Maintenance hemodialysis: hemodialysis prescriptions"[J]. Ther Apher Dial, 2015,19 Suppl 1:67-92.
36. Tiranathanagul K, Susantitaphong P, Srisawat N, Mahatanan N, Tungsanga K, Praditpornsilpa K, et al. Ten-Year Survival of End-Stage Renal Disease Patients Treated with High-Efficiency Online Hemodiafiltration: A Cohort Study of a Center in South East Asia[J]. Nephron, 2018,139(2):150-8.
37. Ward RA. Do clinical outcomes in chronic hemodialysis depend on the choice of a dialyzer[J]? Semin Dial, 2011,24(1):65-71.
38. Bowry SK, Canaud B. Achieving high convective volumes in on-line hemodiafiltration[J]. Blood Purif, 2013,35 Suppl 1:23-8.
39. Yamashita AC. New dialysis membrane for removal of middle molecule uremic toxins[J]. Am J Kidney Dis, 2001,38(4 Suppl 1):S217-9.
40. Joyeux V, Sijpkens Y, Haddj-Elmrabet A, Bijvoet AJ, Nilsson LG. Optimized convective transport with automated pressure control in on-line postdilution hemodiafiltration[J]. Int J Artif Organs, 2008,31(11):928-36.
41. Marcelli D, Scholz C, Ponce P, Sousa T, Kopperschmidt P, Grassmann A, et al. High-volume postdilution hemodiafiltration is a feasible option in routine clinical practice[J]. Artif Organs, 2015,39(2):142-9.
42. Canaud B, Levesque R, Krieter D, Desmeules S, Chalabi L, Moragues H, et al. On-line hemodiafiltration as routine treatment of end-stage renal failure: why pre- or mixed dilution mode is necessary in on-line hemodiafiltration today[J]? Blood Purif, 2004,22 Suppl 2:40-8.
43. Krieter DH, Falkenhain S, Chalabi L, Collins G, Lemke HD, Canaud B. Clinical cross-over comparison of mid-dilution hemodiafiltration using a novel dialyzer concept and post-dilution hemodiafiltration[J]. Kidney Int, 2005,67(1):349-56.
44. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, et al. An Overview of Regular Dialysis Treatment in Japan (As of 31 December 2013) [J]. Ther Apher Dial, 2015,19(6):540-74.
45. Masakane I, Kikuchi K, Kawanishi H. Evidence for the Clinical Advantages of Predilution On-Line Hemodiafiltration[J]. Contrib Nephrol, 2017,189:17-23.
46. Kikuchi K, Hamano T, Wada A, Nakai S, Masakane I. Predilution online hemodiafiltration is associated with improved survival compared with hemodialysis[J]. Kidney Int, 2019,95(4):929-38.
47. Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, et al. Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children - the HDF, heart and height (3H) study[J]. BMC Nephrol, 2018,19(1):199.
48. Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, et al. Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study[J]. J Am Soc Nephrol, 2019,30(4):678-91.
49. Canaud B, Bragg-Gresham JL, Marshall MR, Desmeules S, Gillespie BW, Depner T, et al. Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS[J]. Kidney Int,2006,69(11):2087-93.
50. Locatelli F, Karaboyas A, Pisoni RL, Robinson BM, Fort J, Vanholder R, et al. Mortality risk in patients on hemodiafiltration versus hemodialysis: a 'real-world' comparison from the DOPPS[J]. Nephrol Dial Transplant,2018,33(4):683-9.
51. Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AH, et al. Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes[J]. J Am Soc Nephrol,2012,23(6):1087-96.
52. Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, et al. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: results from the Turkish OL-HDF Study[J]. Nephrol Dial Transplant,2013,28(1):192-202.
53. Penne EL, van der Weerd NC, Bots ML, van den Dorpel MA, Grooteman MP, Levesque R, et al. Patient- and treatment-related determinants of convective volume in post-dilution haemodiafiltration in clinical practice[J]. Nephrol Dial Transplant,2009,24(11):3493-9.
54. Chapdelaine I, Mostovaya IM, Blankestijn PJ, Bots ML, van den Dorpel MA, Levesque R, et al. Treatment policy rather than patient characteristics determines convection volume in online post-dilution hemodiafiltration[J]. Blood Purif, 2014,37(3):229-37.
55. de Roij van Zuijdewijn CLM, Chapdelaine I, Nube MJ, Blankestijn PJ, Bots ML, Konings C, et al. Achieving high convection volumes in postdilution online hemodiafiltration: a prospective multicenter study[J]. Clin Kidney J, 2017,10(6):804-12.
56. Morena M, Jaussent A, Chalabi L, Leray-Moragues H, Chenine L, Debure A, et al. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly[J]. Kidney Int,2017,91(6):1495-509.
57. Maduell F, Moreso F, Pons M, Ramos R, Mora-Macia J, Carreras J, et al. High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients[J]. J Am Soc Nephrol, 2013,24(3):487-97.
58. Mostovaya IM, Blankestijn PJ, Bots ML, Covic A, Davenport A, Grooteman MP, et al. Clinical evidence on hemodiafiltration: a systematic review and a meta-analysis[J]. Semin Dial, 2014,27(2):119-27.
59. Nistor I, Palmer SC, Craig JC, Saglimbene V, Vecchio M, Covic A, et al. Convective versus diffusive dialysis therapies for chronic kidney failure: an updated systematic review of randomized controlled trials[J]. Am J Kidney Dis,2014,63(6):954-67.
60. Wang AY, Ninomiya T, Al-Kahwa A, Perkovic V, Gallagher MP, Hawley C, et al. Effect of hemodiafiltration or hemofiltration compared with hemodialysis on mortality and cardiovascular disease in chronic kidney failure: a systematic review and meta-analysis of randomized trials[J]. Am J Kidney Dis, 2014,63(6):968-78.
61. See EJ, Hedley J, Agar JWM, Hawley CM, Johnson DW, Kelly PJ, et al. Patient survival on haemodiafiltration and haemodialysis: a cohort study using the Australia and New Zealand Dialysis and Transplant Registry[J]. Nephrol Dial Transplant, 2019,34(2):326-38.
62. Lornoy W, De Meester J, Becaus I, Billiouw JM, Van Malderen PA, Van Pottelberge M. Impact of convective flow on phosphorus removal in maintenance hemodialysis patients[J]. J Ren Nutr, 2006,16(1):47-53.
63. Cornelis T, van der Sande FM, Eloot S, Cardinaels E, Bekers O, Damoiseaux J, et al. Acute hemodynamic response and uremic toxin removal in conventional and extended hemodialysis and hemodiafiltration: a randomized crossover study[J]. Am J Kidney Dis,2014,64(2):247-56.
64. Penne EL, van der Weerd NC, van den Dorpel MA, Grooteman MP, Levesque R, Nube MJ, et al. Short-term effects of online hemodiafiltration on phosphate control: a result from the randomized controlled Convective Transport Study (CONTRAST) [J]. Am J Kidney Dis,2010,55(1):77-87.
65. Lin CL, Huang CC, Yu CC, Yang HY, Chuang FR, Yang CW. Reduction of advanced glycation end product levels by on-line hemodiafiltration in long-term hemodialysis patients[J]. Am J Kidney Dis, 2003,42(3):524-31.
66. Mandolfo S, Borlandelli S, Imbasciati E. Leptin and beta2-microglobulin kinetics with three different dialysis modalities[J]. Int J Artif Organs, 2006,29(10):949-55.
67. Patrier L, Dupuy AM, Granger Vallee A, Chalabi L, Morena M, Canaud B, et al. FGF-23 removal is improved by on-line high-efficiency hemodiafiltration compared to conventional high flux hemodialysis[J]. J Nephrol, 2013,26(2):342-9.
68. Carracedo J, Merino A, Nogueras S, Carretero D, Berdud I, Ramirez R, et al. On-line hemodiafiltration reduces the proinflammatory CD14+CD16+ monocyte-derived dendritic cells: A prospective, crossover study[J]. J Am Soc Nephrol, 2006,17(8):2315-21.
69. Panichi V, Rizza GM, Paoletti S, Bigazzi R, Aloisi M, Barsotti G, et al. Chronic inflammation and mortality in haemodialysis: effect of different renal replacement therapies. Results from the RISCAVID study[J]. Nephrol Dial Transplant, 2008,23(7):2337-43.
70. Panichi V, Rosati A, Bigazzi R, Paoletti S, Mantuano E, Beati S, et al. Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study[J]. Nephrol Dial Transplant, 2011,26(8):2641-8.
71. Panichi V, Scatena A, Rosati A, Giusti R, Ferro G, Malagnino E, et al. High-volume online haemodiafiltration improves erythropoiesis-stimulating agent (ESA) resistance in comparison with low-flux bicarbonate dialysis: results of the REDERT study[J]. Nephrol Dial Transplant, 2015,30(4):682-9.
72. van der Weerd NC, Den Hoedt CH, Blankestijn PJ, Bots ML, van den Dorpel MA, Levesque R, et al. Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: results from a randomized controlled trial (CONTRAST) [J]. PLoS One, 2014,9(4):e94434.
73. Susantitaphong P, Siribamrungwong M, Jaber BL. Convective therapies versus low-flux hemodialysis for chronic kidney failure: a meta-analysis of randomized controlled trials[J]. Nephrol Dial Transplant, 2013,28(11):2859-74.
74. Marcelli D, Bayh I, Merello JI, Ponce P, Heaton A, Kircelli F, et al. Dynamics of the erythropoiesis stimulating agent resistance index in incident hemodiafiltration and high-flux hemodialysis patients[J].Kidney Int, 2016,90(1):192-202.
75. Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini LA, et al. Hemofiltration and hemodiafiltration reduce intradialytic hypotension in ESRD[J]. J Am Soc Nephrol, 2010,21(10):1798-807.
76. van der Sande FM, Kooman JP, Konings CJ, Leunissen KM. Thermal effects and blood pressure response during postdilution hemodiafiltration and hemodialysis: the effect of amount of replacement fluid and dialysate temperature[J]. J Am Soc Nephrol, 2001,12(9):1916-20.
77. Molina P, Vizcaino B, Molina MD, Beltran S, Gonzalez-Moya M, Mora A, et al. The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study[J]. Nephrol Dial Transplant, 2018,33(7):1223-35.

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