Chazot Charles, Kirchgessner Judith, Pham Jenny, Vo-Van Cyril, Lorriaux Christie, Hurot Jean-Marc, Zaoui Eric, Grassmann Aileen, Jean Guillaume, Marcelli Daniele
NephroCare Tassin-Charcot, Sainte Foy Les Lyon, France.
Nephron. 2015;129(4):269-75. doi: 10.1159/000380767. Epub 2015 Mar 20.
Survival of haemodialysis (HD) patients is influenced by many factors. Mortality is mainly of cardiovascular (CV) origin and related to both traditional and nontraditional CV risk factors. Low plasma Beta2-microglobulin (β2m) levels are associated with improved HD patient survival. HD session times that are longer than the conventional 4 h (i.e., extended dialysis) provide better middle molecule clearance and are also associated with a survival advantage. In this crossover randomised trial, we investigated the effect of membrane flux on CV risk factors and on β2m plasma levels in patients treated with extended dialysis. Dialysis session duration was between 5 and 8 h for all patients. Patients were randomly assigned to the treatment sequences low-flux/high-flux dialysis versus high-flux/low-flux dialysis in a crossover design after a 3-month run-in period, with each phase lasting 9 months. Of the initially enrolled 168 patients, 155 patients started the study after the run-in period, 117 patients completed Phase 1, and 83 patients completed the whole study. Lp(a), homocystein, LDL cholesterol, HDL cholesterol and serum albumin were comparable in the low-flux and high-flux treatments. The average β2m level was 43.3 ± 11.1 mg/l at the end of the low-flux phase. Independent of sequence assignation, average β2m was significantly lower at the end of the high-flux phase (27.5 ± 76.0 mg/l, p < 0.0001 versus end of low-flux phase). Both phosphate and nPNA were significantly lower at the end of the high-flux phase compared to the low-flux phase (p = 0.045 and p = 0.002, respectively). Inclusion of those patients who completed Phase 1 and who dropped out of the study during Phase 2 did not significantly change the results. In conclusion, this study did not find an influence of high-flux filters on several traditional CV risk factors in a population of HD patients treated with extended dialysis. However, high-flux filters are necessary to optimise middle molecule clearance and reduce the β2m level.
血液透析（HD）患者的生存率受多种因素影响。死亡率主要源于心血管（CV）疾病，与传统和非传统的CV危险因素均有关。低血浆β2微球蛋白（β2m）水平与HD患者生存率提高相关。超过传统4小时的HD治疗时间（即延长透析）能更好地清除中分子物质，也与生存优势相关。在这项交叉随机试验中，我们研究了膜通量对接受延长透析治疗患者的CV危险因素及β2m血浆水平的影响。所有患者的透析治疗时间为5至8小时。经过3个月的导入期后，患者采用交叉设计随机分配到低通量/高通量透析与高通量/低通量透析的治疗序列中，每个阶段持续9个月。最初纳入的168例患者中，155例在导入期后开始研究，117例完成第1阶段，83例完成整个研究。低通量和高通量治疗中脂蛋白（a）、同型半胱氨酸、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和血清白蛋白水平相当。低通量阶段结束时β2m平均水平为43.3±11.1mg/L。不考虑序列分配，高通量阶段结束时平均β2m水平显著降低（27.5±76.0mg/L，与低通量阶段结束时相比，p<0.0001）。与低通量阶段相比，高通量阶段结束时磷酸盐和nPNA均显著降低（分别为p = 0.045和p = 0.002）。纳入完成第1阶段以及在第2阶段退出研究的患者，结果无显著变化。总之，本研究未发现高通量滤器对接受延长透析治疗的HD患者群体中的几种传统CV危险因素有影响。然而，高通量滤器对于优化中分子清除和降低β2m水平是必要的。
