Canaud Bernard, Chénine Leïla, Leray-Moraguès Hélène, Patrier Laure, Rodriguez Annie, Gontier-Picard A, Moréna Marion
Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France; Association pour l'installation à domicile des épurations rénales (Aider), 746, rue de la Croix-de-Lavit, 34192 Montpellier, France; Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France.
Néphrologie, dialyse et soins intensifs, hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34925 Montpellier cedex 5, France; Institut de recherche et formation en dialyse (IRFD), hôpital Lapeyronie, CHRU de Montpellier, 375, avenue du Doyen-Giraud, 34295 Montpellier, France.
Nephrol Ther. 2017 May;13(3):189-201. doi: 10.1016/j.nephro.2017.02.007. Epub 2017 May 5.
Purification of high molecular uremic toxins by conventional hemodialysis is limited. It remains associated with a high morbidity and excessively high mortality. Online hemodiafiltration using a high permeability hemodiafilter, an ultrapure dialysate, and which tends to maximize substitution volumes, provides a high efficiency and low bio-incompatibility renal supplementation. Regular use of online hemodiafiltration is associated with reduced morbidity (reduction of intradialytic hypotension episodes, improved blood pressure control, reduced inflammatory profile, better anemia correction and prevention of β-microglobulin-associated amyloidosis). Recently, several cohort studies have shown that hemodiafiltration with high substitution volume was associated with a significant reduction in mortality. Randomized studies have been conducted in Europe to confirm these facts. The high safety of online hemodiafiltration has been confirmed in clinical practice by prospective studies. Online hemodiafiltration has reached its full maturity phase and is expected to represent the new standard of renal replacement therapy.
通过传统血液透析对高分子量尿毒症毒素的清除是有限的。它仍然伴随着高发病率和过高的死亡率。使用高通透性血液透析滤过器、超纯透析液且倾向于使置换量最大化的在线血液透析滤过，提供了高效且生物不相容性低的肾脏替代治疗。定期使用在线血液透析滤过与发病率降低相关（减少透析中低血压发作、改善血压控制、降低炎症反应、更好地纠正贫血以及预防β-微球蛋白相关淀粉样变性）。最近，几项队列研究表明，高置换量血液透析滤过与死亡率显著降低相关。欧洲已开展随机研究以证实这些事实。前瞻性研究已在临床实践中证实了在线血液透析滤过的高安全性。在线血液透析滤过已进入完全成熟阶段，有望成为肾脏替代治疗的新标准。
