Canaud Bernard, Morena Marion, Leray-Moragues Hélène, Chalabi Lofti, Cristol Jean-Paul
Nephrology, Dialysis and Intensive Care, University Hospital, Montpellier-F, France.
Hemodial Int. 2006 Jan;10 Suppl 1:S5-S12. doi: 10.1111/j.1542-4758.2006.01183.x.
Despite several technical advances in dialysis treatment modalities and a better patient care management including correction of anemia, suppression of secondary hyperparathyroidism, lipid and oxidative stress profiles improvement, the morbidity and the mortality of dialysis patients still remain still elevated. Recent prospective interventional trials in hemodialysis (HEMO study and 4D study) were not very conclusive in showing any significant improvement in dialysis patient outcomes. High-efficiency convective therapies, such as online hemodiafiltration (HDF), are claimed to be superior to conventional diffusive hemodialysis (HD) in improving the dialysis efficacy and in reducing intradialytic morbidity and all-cause and cardiovascular mortality in dialysis patients. The aim of this report was, first, to review the evidence-based facts tending to prove the superiority of HDF vs. HD in terms of efficacy and tolerance, and, second, to analyze the needs to prove the clinical superiority of HDF in terms of reducing morbidity and all-cause mortality of dialysis patients. A systematic review of studies comparing HDF and HD has been performed in the microbiological safety of online production, the solute removal capacity of small and medium-size uremic toxins, and its implication in the reduction of the bioactive dialysis system vs. patient interaction. Major planned randomized international studies comparing HDF and HD in terms of morbidity and mortality have been reviewed. To conclude, it is thought that these long-term prospective randomized trials will clarify on a scientific evidence-based level the putative beneficial role of high-efficiency HDF modalities on dialysis patient outcomes.
尽管透析治疗方式有多项技术进步，且患者护理管理得到改善，包括纠正贫血、抑制继发性甲状旁腺功能亢进、改善脂质和氧化应激状况，但透析患者的发病率和死亡率仍然居高不下。近期针对血液透析的前瞻性干预试验（HEMO研究和4D研究）在显示透析患者结局有任何显著改善方面并非很有说服力。高效对流疗法，如在线血液透析滤过（HDF），据称在提高透析疗效以及降低透析患者的透析期间发病率、全因死亡率和心血管死亡率方面优于传统的扩散性血液透析（HD）。本报告的目的，首先是回顾倾向于证明HDF在疗效和耐受性方面优于HD的循证事实，其次是分析证明HDF在降低透析患者发病率和全因死亡率方面具有临床优势的必要性。已对比较HDF和HD的研究进行了系统评价，内容涉及在线生产的微生物安全性、中小分子尿毒症毒素的溶质清除能力及其在减少生物活性透析系统与患者相互作用方面的意义。已对比较HDF和HD发病率及死亡率的主要国际随机计划研究进行了综述。总之，人们认为这些长期前瞻性随机试验将在基于科学证据的层面上阐明高效HDF模式对透析患者结局可能具有的有益作用。
