扩大血液透析是否是中小分子清除的在线血液透析滤过的一种选择？
Is Expanded Hemodialysis an Option to Online Hemodiafiltration for Small- and Middle-Sized Molecules Clearance?
机构信息
Department of Nephrology, Hospital General Universitario of Castellón, Castellón,
Department of Nephrology, Hospital General Universitario of Castellón, Castellón, Spain.
出版信息
Blood Purif. 2019;47(1-3):126-131. doi: 10.1159/000493910. Epub 2018 Oct 12.
BACKGROUND
Recent evidence suggests a better reduction rate of some uremic toxins with expanded hemodialysis (HDx).
METHODS
Prospective study including 8 hemodialysis patients. We divided the study in 2 phases; within the first one, we assigned 4 patients (group 1) to undergo online hemodiafiltration with a PF 210H dialyzer, and the other 4 patients (group 2) to undergo HDx with the high retention onset Theranova 500 dialyzer during 24 sessions. Later, during the second phase and after a washout period, the same patients were switched to receive HDx (group 1) and HDF (group 2).
RESULTS
No differences were found in the Urea and β2-microglobulin reduction ratio. However, in the case of myoglobin, the reduction ratio with HDF was 35 vs. 60% with HDx (p < 0.001). Similarly, in the case of prolactin, the reduction ratio with HDF was 45 and 61% with HDx (p < 0.001).
CONCLUSIONS
We conclude that HDx is not inferior to online hemodiafiltration in the clearance of small and middle molecules and could be superior in the clearance of larger middle molecules.
背景
最近的证据表明，扩大血液透析（HDx）可以更好地降低某些尿毒症毒素的水平。
方法
本研究为前瞻性研究，纳入了 8 名血液透析患者。我们将研究分为 2 个阶段；在第一阶段，我们将 4 名患者（第 1 组）分配到使用 PF 210H 透析器进行在线血液透析滤过，另外 4 名患者（第 2 组）使用高截留起始 Theranova 500 透析器进行 HDx，共进行 24 次治疗。之后，在第二阶段并经过洗脱期后，相同的患者被切换到接受 HDx（第 1 组）和 HDF（第 2 组）治疗。
结果
在尿素和β2-微球蛋白的清除率方面，两组之间没有差异。然而，在肌红蛋白方面，HDF 的清除率为 35%，而 HDx 的清除率为 60%（p < 0.001）。同样，在催乳素方面，HDF 的清除率为 45%，而 HDx 的清除率为 61%（p < 0.001）。
结论
我们得出结论，HDx 在清除小分子和中分子物质方面并不逊于在线血液透析滤过，并且在清除较大的中分子物质方面可能更具优势。
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