Chu Pei-Lun, Chiu Yen-Ling, Lin Jou-Wei, Chen Shih-I, Wu Kwan-Dun
Duke University, Cell and Molecular Biology Program, Durham, NC, USA.
Blood Purif. 2008;26(2):213-20. doi: 10.1159/000117440. Epub 2008 Feb 20.
Cardiovascular disease (CVD) is the leading cause of mortality in patients with end-stage renal disease (ESRD). The cornerstone of high CVD incidence in ESRD patients is endothelial dysfunction which results from inflammation, oxidative stress and insulin resistance. Although various modalities of hemodialysis (HD) have been presumed to exert different effects on oxidative stress and insulin resistance, solid evidence is still lacking.
40 ESRD patients undergoing HD were prospectively enrolled and divided randomly into two groups. Patients in each group received either F8 HPS (low-flux) (Group A) or FX80 (high-flux) (Group B) as HD dialyzers for 2 consecutive months. Diet pattern and medications were kept as usual in both groups to avoid considerable blood glucose change during study period. Blood samples were taken at the start and end of the study.
A total of 38 patients (18 and 20 for Groups A and B, respectively) completed the study. Within each group, there was no change in adiponectin, plasma 8-iso-prostaglandin F(2)(alpha), high-sensitivity C-reactive protein, blood glucose and insulin after 2 months of treatment except a significant change of HOMA(IR) (p = 0.02) in high-flux group. The significant change of HOMA(IR) between the two groups (p = 0.017) mainly results from the parallel change of insulin between the two groups (p = 0.03).
For patients receiving HD, the high-flux dialyzer with synthetic polysulfone membranes fails to provide a better anti-inflammatory or antioxidative effect than the low-flux dialyzer; however, the high-flux dialyzer does significantly improve insulin resistance in this short-term study. This result implies that the high-flux dialyzer might provide better cardiovascular protection than the low-flux dialyzer. Therefore, the low-flux dialyzer might be considered for patients who only need short-term HD therapy. Regarding patients under long-term maintenance HD therapy, a high-flux dialyzer might be the choice of dialyzer.
心血管疾病（CVD）是终末期肾病（ESRD）患者死亡的主要原因。ESRD患者心血管疾病高发病率的关键是内皮功能障碍，其由炎症、氧化应激和胰岛素抵抗引起。尽管各种血液透析（HD）方式被认为对氧化应激和胰岛素抵抗有不同影响，但仍缺乏确凿证据。
前瞻性纳入40例接受HD的ESRD患者并随机分为两组。每组患者连续2个月分别使用F8 HPS（低通量）（A组）或FX80（高通量）（B组）作为HD透析器。两组的饮食模式和药物治疗保持不变，以避免研究期间血糖大幅变化。在研究开始和结束时采集血样。
共有38例患者（A组18例，B组20例）完成研究。每组内，治疗2个月后脂联素、血浆8-异前列腺素F2α、高敏C反应蛋白、血糖和胰岛素均无变化，但高通量组的胰岛素抵抗稳态模型评估（HOMA-IR）有显著变化（p = 0.02）。两组间HOMA-IR的显著变化（p = 0.017）主要源于两组间胰岛素的平行变化（p = 0.03）。
对于接受HD的患者，具有合成聚砜膜材质的高通量透析器在抗炎或抗氧化方面并不比低通量透析器效果更好；然而，在这项短期研究中，高通量透析器确实能显著改善胰岛素抵抗。这一结果表明，高通量透析器可能比低通量透析器提供更好的心血管保护。因此，对于仅需要短期HD治疗的患者，可考虑使用低通量透析器。对于长期维持性HD治疗的患者，高通量透析器可能是透析器的选择。
