Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Juan Badiano No. 1, Col Sección XVI, Tlalpan, CP 14080, Mexico City, DF, Mexico,
Int Urol Nephrol. 2013 Oct;45(5):1373-8. doi: 10.1007/s11255-012-0324-8. Epub 2012 Nov 10.
BACKGROUND/AIM: Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease and has a strong association with hyperphosphatemia. Dialysis is the major treatment tool for attaining serum phosphorus control. Phosphorus removal can be increased with hemodiafiltration. We compared the effect of hemodiafiltration and hemodialysis on serum phosphorus and phosphorus removal and changes in cardiovascular variables in a short-term follow-up.
Adult patients with end-stage renal disease were randomized to receive hemodialysis or hemodiafiltration for 3 months. Clinical and biochemical variables were recorded monthly. Cardiac resonance was done at randomization and at the end of follow-up.
A total of 24 patients were studied (10 in hemodialysis and 14 in hemodiafiltration) with a mean age of 34.7 ± 11.4 years. The two groups did not differ as for age and blood pressure control at baseline. Phosphorus removal was higher (1,099 ± 239 in hemodiafiltration vs. 864 ± 366 mmol/session in hemodialysis, p < 0.05) and serum phosphorus was lower in the hemodiafiltration group at the end of follow-up (3.4 ± 0.8 in hemodiafiltration vs. 4.5 ± 1.6 mg/dl in hemodialysis, p < 0.05). We found a significant increase in ejection fraction only in the hemodiafiltration group. There was a trend to smaller increase in myocardial mass and a decrease in left ventricular end-diastolic volume only in the hemodiafiltration group. The changes in cardiac variables were significantly associated with changes in serum phosphorus levels.
Hemodiafiltration was associated with better control of serum phosphorus and improvement in left ventricular ejection fraction, compared with hemodialysis.
背景/目的：心血管疾病是慢性肾脏病患者死亡的主要原因，与高磷血症密切相关。透析是实现血清磷控制的主要治疗手段。血液透析滤过可增加磷的清除。我们比较了血液透析滤过和血液透析对短期随访中血清磷和磷清除以及心血管变量变化的影响。
将终末期肾病成年患者随机分为血液透析或血液透析滤过组，分别接受 3 个月的治疗。每月记录临床和生化变量。在随机分组时和随访结束时进行心脏磁共振检查。
共纳入 24 例患者（血液透析组 10 例，血液透析滤过组 14 例），平均年龄 34.7 ± 11.4 岁。两组在基线时的年龄和血压控制方面没有差异。血液透析滤过组磷清除率更高（1099 ± 239mmol/session 比血液透析组 864 ± 366mmol/session，p<0.05），随访结束时血清磷水平更低（血液透析滤过组 3.4 ± 0.8mg/dl 比血液透析组 4.5 ± 1.6mg/dl，p<0.05）。我们发现仅在血液透析滤过组中射血分数显著增加。仅在血液透析滤过组中，心肌质量有增加趋势，左心室舒张末期容积减少。心脏变量的变化与血清磷水平的变化显著相关。
与血液透析相比，血液透析滤过可更好地控制血清磷水平，改善左心室射血分数。
