Lin C L, Yang C W, Chiang C C, Chang C T, Huang C C
Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
Blood Purif. 2001;19(3):301-7. doi: 10.1159/000046958.
Hemodiafiltration (HDF) is effective in delaying the surgical need for carpal tunnel syndrome in chronic hemodialysis patients, however, predialysis beta(2)-microglobulin levels were not reduced in most short-term studies. The aim of this study was to assess the effect of long-term and differing frequencies of on-line HDF on serum beta(2)-microglobulin levels in comparison to high-flux hemodialysis (HD).
One hundred and twelve patients in the Chang Gung Memorial Hospital Dialysis Unit were divided into three groups to receive different frequencies of on-line HDF alternating with high-flux HD. Group 1 was treated once with HDF and twice with high-flux HD per week (n = 21). Group 2 was treated twice with HDF and once with high-flux HD per week (n = 33). Group 3 was treated with HDF three times per week (n = 58). Analysis was performed to compare the serum beta(2)-microglobulin levels in these groups and to high-flux HD.
After receiving HDF for a mean of 7.9 months, group 3 patients had a reduced predialysis beta(2)-microglobulin level (22.2 +/-5.3 vs. 34.8 +/-6.3 mg/l, p < 0.001), postdialysis beta(2)-microglobulin level (6.3 +/- 2.0 vs. 13.8 +/- 6.8 mg/l, p < 0.001) and an increased beta(2)-microglobulin reduction rate (76.1 +/- 5.6 vs. 61.1 +/- 13.3%, p = 0.03) when compared to high-flux HD. A significant improvement in URR (p = 0.0004), Kt/V (p = 0.0002) and TAC urea levels (p = 0.006) but not nPCR (p = 0.122) was found after patients had been treated with on-line HDF. The beta(2)-microglobulin reduction rate was positively correlated with the overall volume of the replacement solution per session (p < 0.0001). Patients in group 3 had lower predialysis beta(2)-microglobulin levels than those in group 1 and group 2 (22.2 +/- 5.3 vs. 25.2 +/- 7.2 vs. 26.0 +/- 4.2 mg/l, p = 0.02). Furthermore, an inverse correlation was found between the predialysis beta(2)-microglobulin level and the duration of HDF, if patients were treated for more than 12 months (p = 0.031).
On-line HDF has an increased dialysis efficiency compared to high-flux dialysis. Long-term HDF further reduced predialysis beta(2)-microglobulin levels, thus, it may provide an improved modality for renal replacement therapy.
血液透析滤过（HDF）对延缓慢性血液透析患者腕管综合征的手术需求有效，然而，在大多数短期研究中，透析前β2-微球蛋白水平并未降低。本研究的目的是评估与高通量血液透析（HD）相比，长期不同频率的在线HDF对血清β2-微球蛋白水平的影响。
长庚纪念医院透析科的112例患者被分为三组，接受不同频率的在线HDF与高通量HD交替治疗。第1组每周接受1次HDF和2次高通量HD治疗（n = 21）。第2组每周接受2次HDF和1次高通量HD治疗（n = 33）。第3组每周接受3次HDF治疗（n = 58）。进行分析以比较这些组与高通量HD组的血清β2-微球蛋白水平。
在平均接受HDF 7.9个月后，与高通量HD相比，第3组患者透析前β2-微球蛋白水平降低（22.2±5.3 vs. 34.8±6.3 mg/l，p < 0.001），透析后β2-微球蛋白水平降低（6.3±2.0 vs. 13.8±6.8 mg/l，p < 0.001），β2-微球蛋白降低率增加（76.1±5.6 vs. 61.1±13.3%，p = 0.03）。患者接受在线HDF治疗后，尿素清除率（URR）（p = 0.0004）、Kt/V（p = 0.0002）和TAC尿素水平（p = 0.006）有显著改善，但标准化蛋白分解率（nPCR）无显著改善（p = 0.122）。β2-微球蛋白降低率与每次治疗的置换液总体积呈正相关（p < 0.0001）。第3组患者透析前β2-微球蛋白水平低于第1组和第2组（22.2±5.3 vs. 25.2±7.2 vs. 26.0±4.2 mg/l，p = 0.02）。此外，如果患者治疗超过12个月，透析前β2-微球蛋白水平与HDF持续时间呈负相关（p = 0.031）。
与高通量透析相比，在线HDF具有更高透析效率。长期HDF进一步降低透析前β2-微球蛋白水平，因此，它可能为肾脏替代治疗提供一种更好的方式。
