Department of Internal Medicine, Myongji Hospital, Goyang, Korea.
Department of Internal Medicine, Kwandong University College of Medicine, Gangneung, Korea.
Kidney Res Clin Pract. 2013 Sep;32(3):127-33. doi: 10.1016/j.krcp.2013.06.002. Epub 2013 Jul 10.
The autonomic nervous system plays a central role in the maintenance of hemodynamic stability. Cardiac autonomic dysfunction may result in serious complications, such as sudden cardiac death. Heart rate variability (HRV) is significantly reduced in patients undergoing chronic hemodialysis (HD). The aim of this study was to evaluate the effect of on-line hemodiafiltration (OL-HDF) on the autonomic nervous system in chronic HD patients.
Forty chronic HD patients were prospectively studied. The participants were divided into conventional HD and OL-HDF groups. They received regular high-flux HD or OL-HDF for 4-hour sessions, three times a week. Time-and frequency-domain measures of the 24-hour HRV were analyzed during the interdialytic period prior to postdilution OL-HDF and every 6 months for 24 months. The 7-year survival was also evaluated.
Among the 40 participants, 15 patients in the HD group and 11 patients in the OL-HDF group completed the study. There was no difference in the baseline characteristics. After 24 months of treatment, β2-microglobulin concentration decreased (from 33.4±15.2 mg/dL to 28.4±6.2 mg/dL, P =0.02) in the OL-HDF group, while there was no change in the HD group. In the HRV analysis, the frequency-domain HRV parameters increased significantly compared with baseline in the OL-HDF group [natural logarithmic high frequency (lnHF), 3.15±3.36 ms(2) vs. 4.42±3.81 ms(2); ln low frequency (LF), 3.56±3.17 ms(2) vs. 4.78±3.99 ms(2); ln very low frequency (VLF), 4.90±4.62 ms(2) vs. 6.38±5.54 ms(2); LF/HF ratio, 1.4±0.4 vs. 2.5±0.1]. The survival rate was similar between the groups.
This study shows that OL-HDF improved autonomic nervous system dysfunction in chronic HD patients.
自主神经系统在维持血液动力学稳定方面起着核心作用。心脏自主神经功能障碍可能导致严重并发症，如心源性猝死。慢性血液透析（HD）患者的心率变异性（HRV）显著降低。本研究旨在评估在线血液透析滤过（OL-HDF）对慢性 HD 患者自主神经系统的影响。
前瞻性研究 40 例慢性 HD 患者。将参与者分为常规 HD 和 OL-HDF 组。他们分别接受常规高通量 HD 或 OL-HDF，每次 4 小时，每周 3 次。在 OL-HDF 后稀释前的透析间期和 24 个月的每 6 个月分析 24 小时 HRV 的时频域指标。还评估了 7 年的生存率。
在 40 名参与者中，HD 组 15 例和 OL-HDF 组 11 例完成了研究。两组的基线特征无差异。治疗 24 个月后，OL-HDF 组β2-微球蛋白浓度降低（从 33.4±15.2mg/dL 降至 28.4±6.2mg/dL，P=0.02），而 HD 组无变化。在 HRV 分析中，OL-HDF 组与基线相比，频域 HRV 参数显著增加[自然对数高频（lnHF），3.15±3.36ms(2)vs.4.42±3.81ms(2)；ln 低频（LF），3.56±3.17ms(2)vs.4.78±3.99ms(2)；ln 极低频（VLF），4.90±4.62ms(2)vs.6.38±5.54ms(2)；LF/HF 比值，1.4±0.4vs.2.5±0.1]。两组的生存率相似。
本研究表明，OL-HDF 改善了慢性 HD 患者的自主神经功能障碍。
