Macías Nicolás, Vega Almudena, Abad Soraya, Santos Alba, Cedeño Santiago, Linares Tania, García-Prieto Ana María, Aragoncillo Inés, Yuste Claudia, López-Gómez Juan Manuel
Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain.
Ther Apher Dial. 2017 Aug;21(4):361-369. doi: 10.1111/1744-9987.12602.
Chronic malnutrition is a common problem in patients with end-stage renal disease on hemodialysis. Some studies have reported albumin loss into dialysis fluid during postdilution online hemodiafiltration (OL-HDF). The aim of the study was to assess the nutritional status of patients on high-volume OL-HDF and to demonstrate that higher convective clearances are not associated with malnutrition due to possible loss of nutrients with ultrafiltration. Demographic and clinical data, corporal composition with bioimpedance spectroscopy, dialysis features, albumin loss into dialysis fluid and laboratory parameters were collected in twenty-eight patients with ESRD undergoing postdilution OL-HDF with stable convective volumes over 28 L/session. Convective volume (CV) in the last six months was 32.51 ± 3.52 L per session. Cross-sectional analysis of dialysis features showed 32.7 ± 3.34 L of CV and high reduction rates of beta-2-microglobulin (84.2 ± 3.8%) and cystatin-C (81.6 ± 3.47%). Beta-2-microglobulin reduction showed a positive correlation with prealbumin levels (P = 0.048). CV was only correlated with cystatin-C reduction (P = 0.025). Estimated albumin loss into dialysis fluid (1.82 ± 1.05 g/session) was not related to laboratory or bioimpedance nutritional parameters, or to CV. Among patients with higher CV, serum albumin levels maintained more stability during the observational period. High volume OL-HDF results in better convective clearances and is not associated with malnutrition. Albumin and nutrients loss into dialysis fluid should not be a limiting factor of the substitution volume.
慢性营养不良是终末期肾病血液透析患者的常见问题。一些研究报告称，在后置稀释在线血液透析滤过（OL-HDF）过程中白蛋白会丢失到透析液中。本研究的目的是评估接受大剂量OL-HDF治疗患者的营养状况，并证明较高的对流清除率不会因超滤可能导致营养物质丢失而与营养不良相关。收集了28例接受后置稀释OL-HDF治疗且对流体积稳定超过28L/次的终末期肾病患者的人口统计学和临床数据、生物电阻抗光谱法测定的身体成分、透析特征、透析液中白蛋白丢失情况以及实验室参数。过去六个月的对流体积（CV）为每次治疗32.51±3.52L。透析特征的横断面分析显示，CV为32.7±3.34L，β2微球蛋白（84.2±3.8%）和胱抑素-C（81.6±3.47%）的清除率较高。β2微球蛋白清除率与前白蛋白水平呈正相关（P=0.048）。CV仅与胱抑素-C清除率相关（P=0.025）。估计透析液中白蛋白丢失量（1.82±1.05g/次）与实验室或生物电阻抗营养参数以及CV均无关。在CV较高的患者中，观察期内血清白蛋白水平保持更稳定。大剂量OL-HDF可实现更好的对流清除率，且与营养不良无关。白蛋白和营养物质丢失到透析液中不应成为置换量的限制因素。
