Panichi Vincenzo, De Ferrari Giacomo, Saffioti Stefano, Sidoti Antonino, Biagioli Marina, Bianchi Stefano, Imperiali Patrizio, Gabbrielli Claudio, Conti Paolo, Patrone Pietro, Falqui Valeria, Rombolà Giuseppe, Mura Carlo, Icardi Andrea, Mulas Donatella, Rosati Alberto, Santori Francesco, Mannarino Antonio, Tomei Valeria, Bertucci Andrea, Steckiph Denis, Palla Roberto
Dialysis and Nephrology Unit, Versilia Hospital, Lido of Camaiore - Italy.
Int J Artif Organs. 2012 Jun;35(6):435-43. doi: 10.5301/ijao.5000106.
Mixed diffusive-convective dialysis therapies offer greater removal capabilities than conventional dialysis. The aim of this study was to compare two different on-line, post-dilution hemodiafiltration (HDF) treatments with regard to achieved convective volume and middle-molecule dialysis efficiency: standard volume control (sOL-HDF) and automated control of the transmembrane pressure (TMP) (UC-HDF).
We enrolled 30 ESRD patients (55.9 ± 14.0 years, 20/10 M/F) in a randomized, prospective, cross-over study. The patients received a 3-month period of sOL-HDF followed by UC-HDF for a further 3 months, or vice versa, using the same dialysis machine. In sOL-HDF, fixed exchange volumes were set according to a filtration fraction greater than or equal to 25%. In UC-HDF therapy, the exchanged volume was driven by a biofeedback system controlling the TMP and its set point in a double loop. Patients maintained their treatment time, dialyzer, blood flow rate, and anticoagulant regimen unchanged throughout the study.
Greater convective volumes were achieved in UC-HDF than in sOL-HDF (23.8 ± 3.9 vs.19.8 ± 4.8 L; p<0.001) with high pre-dialysis Ht value (sOL-HDF 34.0 ± 4.5% and UC-HDF 34.0 ± 4.4%; p = 0.91). The average clearance values of ß2m and P were higher in UC-HDF than in sOL-HDF (respectively 123 ± 24 vs. 111 ± 22 ml/min, p<0.002 and 158 ± 26 vs. 152 ± 25 ml/min, p<0.05). Moreover, the UC-HDF mode led to a significantly increased rate of call-free sessions from 88% to 97% (p<0.0001).
This study showed that the biofeedback module, applied to the automatic control of TMP in on-line HDF, results in higher convective volumes and correspondingly higher ß2m and P clearances. By making the HDF treatment more automated and less complex to perform, it significantly reduced the staff workload.
混合扩散对流透析疗法比传统透析具有更强的清除能力。本研究的目的是比较两种不同的在线后稀释血液透析滤过（HDF）治疗在对流体积和中分子透析效率方面的差异：标准容量控制（sOL-HDF）和跨膜压（TMP）自动控制（UC-HDF）。
我们纳入了30例终末期肾病患者（年龄55.9±14.0岁，男20例/女10例）进行一项随机、前瞻性、交叉研究。患者先接受3个月的sOL-HDF治疗，然后再使用同一台透析机接受3个月的UC-HDF治疗，或反之。在sOL-HDF中，根据大于或等于25%的滤过分数设置固定的置换量。在UC-HDF治疗中，置换量由一个生物反馈系统驱动，该系统在双回路中控制TMP及其设定点。在整个研究过程中，患者的治疗时间、透析器、血流速率和抗凝方案保持不变。
与sOL-HDF相比，UC-HDF实现了更大的对流体积（23.8±3.9对19.8±4.8L；p<0.001），透析前血细胞比容值较高（sOL-HDF为34.0±4.5%，UC-HDF为34.0±4.4%；p = 0.91）。UC-HDF中β2微球蛋白和P的平均清除值高于sOL-HDF（分别为123±24对111±22ml/min，p<0.002；158±26对152±25ml/min，p<0.05）。此外，UC-HDF模式使无故障治疗时段的比例从88%显著提高到97%（p<0.0001）。
本研究表明，应用于在线HDF中TMP自动控制的生物反馈模块可导致更高的对流体积以及相应更高的β2微球蛋白和P清除率。通过使HDF治疗更加自动化且操作更简单，它显著减少了工作人员的工作量。
