Weiss L G, Danielson B G, Wikström B
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Scand J Urol Nephrol. 1989;23(3):223-9. doi: 10.3109/00365598909180846.
Thirty patients with end-stage renal disease were switched from maintenance hemodialysis to postdilution hemofiltration and observed for long-term effects. The study comprised totally 496 months of hemofiltration. Uremic and biochemical control was similar in the hemofiltration and in the hemodialysis period. Of the small molecules, only serum creatinine showed slight increase after 3 months. No other significant changes in creatinine, serum urea or potassium levels were associated with long-term hemofiltration. During each hemofiltration session there was significant decrease of serum parathyroid hormone (PTH) and serum beta 2-microglobulin, but over the first 8 months of hemofiltration the beta 2-microglobulin values did not fall, and significant PTH reduction was found only after 12 months. Although uremic control was similar with both methods, there were fewer complications of hemofiltration, which was preferred by the patients. Because it is currently more expensive, however, hemofiltration should be reserved for patients with dialysis related problems, that are not helped by other changes in the dialysis technique, such as sequential ultrafiltration changes in the dialysis membranes and in the dialysis buffer from acetate to bicarbonate.
30例终末期肾病患者从维持性血液透析转为后置稀释血液滤过，并观察其长期效果。该研究共进行了496个月的血液滤过。血液滤过期间和血液透析期间的尿毒症及生化指标控制情况相似。在小分子物质中，仅血清肌酐在3个月后略有升高。长期血液滤过未导致肌酐、血清尿素或钾水平出现其他显著变化。在每次血液滤过治疗期间，血清甲状旁腺激素（PTH）和血清β2-微球蛋白均显著下降，但在血液滤过的前8个月，β2-微球蛋白值并未下降，仅在12个月后才发现PTH有显著降低。尽管两种方法对尿毒症的控制相似，但血液滤过的并发症较少，患者更倾向于选择血液滤过。然而，由于目前血液滤过费用更高，应仅用于那些存在透析相关问题、且透析技术的其他改变（如透析膜的序贯超滤改变以及透析缓冲液从醋酸盐改为碳酸氢盐）无法解决问题的患者。
