Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain.
Department of Biochemistry, Hospital Clínic Barcelona, Barcelona, Spain.
Ther Apher Dial. 2020 Aug;24(4):387-392. doi: 10.1111/1744-9987.13440. Epub 2019 Nov 10.
Blood flow (Qb) is one of the dialysis parameters most strongly influencing the performance of dialysis modalities. However, few studies have compared different dialysis modalities in patients with low Qb. We conducted a prospective, single-center study in 21 patients. Each patient underwent four dialysis sessions with routine dialysis parameters: high-flux hemodialysis (HD), predilution hemodiafiltration (pre-HDF), expanded HD (HDx), and postdilution HDF (post-HDF). The removal ratios (RR) of urea, creatinine, ß -microglobulin, myoglobin, prolactin, α -microglobulin, free kappa and lambda immunoglobulin light chains (ķFLC and λFLC), α -acid glycoprotein, and albumin were compared intraindividually. A proportional part of the dialysate was collected to quantify albumin loss. There were no differences in urea and creatinine RRs. The β -microglobulin RR was higher in pre-HDF and post-HDF. Myoglobin and prolactin RRs were higher with HDx and post-HDF. The α -microglobulin and α -acid glycoprotein RRs were significantly higher with post-HDF than with other treatments, and RRs obtained with HDx were higher than obtained with HD and pre-HDF. Free ķFLC and λFLC RRs showed the following results in ascending order: HD, pre-HDF, HDx, and post-HDF, most of them with statistical significance. Albumin loss varied from 0.45 g with HD to 3.5 g with post-HDF. The global removal score values were 41.0 ± 4.8% with HD, 44.0 ± 5.2% with pre-HDF, 49.5 ± 4.6% with HDx, and 54.8 ± 5.3% with post-HDF, with significant differences between all treatment modalities. In conclusion, this study confirms the superiority of post-HDF over high-flux HD, pre-HDF, and HDx in patients with low Qb. HDx was the closest alternative to post-HDF and was clearly superior to HD and pre-HDF. Finally, pre-HDF was also superior to HD. With this Qb, there was a higher risk of underdialysis, both diffusive and convective, especially in patients with a session duration of less than 5 h.
血流（Qb）是影响透析方式性能的最重要透析参数之一。然而，很少有研究比较低 Qb 患者的不同透析方式。我们进行了一项前瞻性、单中心研究，纳入了 21 名患者。每位患者接受了四种常规透析参数的透析：高通量血液透析（HD）、预稀释血液透析滤过（pre-HDF）、扩展 HD（HDx）和后稀释血液透析滤过（post-HDF）。个体内比较了尿素、肌酐、ß-微球蛋白、肌红蛋白、催乳素、α-微球蛋白、游离 κ 和 λ 免疫球蛋白轻链（ķFLC 和 λFLC）、α-酸性糖蛋白和白蛋白的清除率（RR）。收集部分透析液以定量白蛋白丢失。尿素和肌酐 RR 无差异。pre-HDF 和 post-HDF 的 ß-微球蛋白 RR 较高。HDx 和 post-HDF 的肌红蛋白和催乳素 RR 较高。与其他治疗方法相比，post-HDF 的 α-微球蛋白和 α-酸性糖蛋白 RR 明显更高，HDx 的 RR 高于 HD 和 pre-HDF。游离 κFLC 和 λFLC RR 结果依次升高：HD、pre-HDF、HDx 和 post-HDF，大多数具有统计学意义。白蛋白丢失从 HD 的 0.45g 到 post-HDF 的 3.5g 不等。HD 的总清除评分值为 41.0±4.8%，pre-HDF 为 44.0±5.2%，HDx 为 49.5±4.6%，post-HDF 为 54.8±5.3%，所有治疗方式之间均有显著差异。总之，本研究证实了 post-HDF 在低 Qb 患者中优于高通量 HD、pre-HDF 和 HDx。HDx 是 post-HDF 的最接近替代方法，明显优于 HD 和 pre-HDF。最后，pre-HDF 也优于 HD。在这种 Qb 下，无论是扩散还是对流，都有透析不足的更高风险，尤其是在 session 持续时间少于 5 小时的患者中。
