Uhlin Fredrik, Odar-Cederlöf Ingegerd, Theodorsson Elvar, Fernström Anders
Department of Nephrology, Region Östergötland, Linköping, Sweden ; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden ; Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Tallinn, Estonia.
Department of Clinical Pharmacology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Nephron Extra. 2015 Oct 28;5(3):67-78. doi: 10.1159/000440816. eCollection 2015 Sep-Dec.
BACKGROUND/AIMS: Plasma concentrations of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) are increased in end-stage renal disease. Improvement in hemodynamic stability has been reported when switching from hemodialysis (HD) to on-line hemodiafiltration (ol-HDF). The aim of this study was to investigate plasma concentrations of NT-proBNP, BNP and neuropeptide Y (NPY) during a 1-year follow-up, after a change from high-flux HD to postdilution ol-HDF. Additional variables were also studied, e.g. pulse wave velocity and ordinary clinical parameters.
We conducted a prospective, single-center study including 35 patients who were switched from HD to HDF. Plasma concentrations of NT-proBNP, BNP and NPY before and after dialysis were measured at baseline (i.e. HD) and at 1, 2, 4, 6 and 12 months on HDF.
All three peptide levels decreased significantly during HD and HDF when comparing concentrations before and after dialysis. Mean absolute value (before/after) and relative decrease (%) before versus after dialysis was 13.697/9.497 ng/l (31%) for NT-proBNP, 62/40 ng/ml (35%) for BNP and 664/364 pg/l (45%) for NPY. No significant differences were observed when comparing predialysis values over time. However, postdialysis NT-proBNP concentration showed a significant decrease of 48% over time after the switch to HDF.
The postdialysis plasma levels of NT-proBNP, BNP and NPY decreased significantly during both dialysis modes when compared to before dialysis. The postdialysis lowering of NT-proBNP increased further over time after the switch to ol-HDF; the predialysis levels were unchanged, suggesting no effect on its production in the ventricles of the heart.
背景/目的：终末期肾病患者血浆中脑钠肽前体N端片段（NT-proBNP）浓度升高。据报道，从血液透析（HD）转换为在线血液透析滤过（ol-HDF）后，血流动力学稳定性有所改善。本研究的目的是在从高通量HD转换为后置稀释ol-HDF后的一年随访期间，研究NT-proBNP、脑钠肽（BNP）和神经肽Y（NPY）的血浆浓度。还研究了其他变量，如脉搏波速度和常规临床参数。
我们进行了一项前瞻性单中心研究，纳入35例从HD转换为HDF的患者。在基线（即HD）以及HDF治疗的1、2、4、6和12个月时，测量透析前后血浆中NT-proBNP、BNP和NPY的浓度。
比较透析前后的浓度时，HD和HDF期间所有三种肽水平均显著降低。NT-proBNP透析前后的平均绝对值（之前/之后）和相对降低率（%）分别为13.697/9.497 ng/l（31%），BNP为62/40 ng/ml（35%），NPY为664/364 pg/l（45%）。比较不同时间的透析前值时未观察到显著差异。然而，转换为HDF后，透析后NT-proBNP浓度随时间显著降低了48%。
与透析前相比，两种透析模式下透析后血浆中NT-proBNP、BNP和NPY水平均显著降低。转换为ol-HDF后，透析后NT-proBNP的降低随时间进一步增加；透析前水平未改变，表明对其在心室中的产生没有影响。
