Lee Yu Ho, Shin Yoon Soo, Lee So-Young, Kim Yang Gyun, Lee Sang Ho, Moon Ju Young, Jeong Kyung Hwan, Hwang Hyeon Seok, Ahn Shin Young, Lee Hong Joo, Lee Dong-Young, Ko Eun-Jung, Cho Hye Jeong, Yang Dong Ho, Jeong Hye Yun
Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2020 Mar 31;39(1):103-111. doi: 10.23876/j.krcp.19.082.
Online hemodiafiltration (OL-HDF) offers considerable advantages in clearance of molecules of various sizes. However, evidence of clinical effects of OL-HDF is scarce in Korea. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF.
Adult patients with end-stage renal disease undergoing hemodialysis (HD) were prospectively enrolled in a K-cohort (CRIS no. KCT0003281) from 6 tertiary hospitals in South Korea. We recruited 435 patients, 339 of whom were on HD at enrollment. One hundred eighty-two patients were followed for more than 24 months. Among them, 44 were switched to OL-HDF for more than 12 months without conversion to HD. We used a paired test to compare baseline and 24-month follow-up results.
The mean age of the subjects was 61.2 ± 12.2 years, and 62.6% were male. The baseline hemoglobin level was not significantly different between HD and OL-HDF group (10.61 ± 1.15 vs. 10.46 ± 1.03 g/dL, = 0.437). However, the baseline serum protein and albumin levels were significantly lower in the OL-HDF group (6.82 ± 0.49 vs. 6.59 ± 0.48 g/dL, = 0.006; 3.93 ± 0.28 vs. 3.73 ± 0.29 g/dL, < 0.001). In patients switched to OL-HDF, levels of hemoglobin and serum albumin significantly increased (10.46 ± 1.03 vs. 11.08 ± 0.82 g/dL, = 0.001; 3.73 ± 0.29 vs. 3.87 ± 0.30 g/dL, = 0.001). The normalized protein catabolic rate decreased after 24 months, but the change was not significant (1.07 ± 0.25 vs. 1.03 ± 0.21 g/kg/day, = 0.433). Although the dose of erythropoiesis-stimulating agent was lower in patients who converted to HDF, it was not significantly different (-115.7 ± 189.7 vs. -170.5 ± 257.1 = 0.206).
OL-HDF treatment over more than 12 months was associated with no harmful effects on anemia and nutritional status.
联机血液透析滤过（OL-HDF）在清除各种大小分子方面具有显著优势。然而，在韩国，OL-HDF临床效果的证据很少。在本研究中，我们调查了转换为OL-HDF超过12个月后实验室指标的变化。
来自韩国6家三级医院的终末期肾病接受血液透析（HD）的成年患者被前瞻性纳入一个韩国队列（CRIS编号KCT0003281）。我们招募了435例患者，其中339例在入组时接受HD治疗。182例患者随访超过24个月。其中，44例转换为OL-HDF超过12个月且未转换回HD治疗。我们使用配对检验比较基线和24个月随访结果。
受试者的平均年龄为61.2±12.2岁，男性占62.6%。HD组和OL-HDF组的基线血红蛋白水平无显著差异（10.61±1.15 vs. 10.46±1.03 g/dL，P = 0.437）。然而，OL-HDF组的基线血清蛋白和白蛋白水平显著更低（6.82±0.49 vs. 6.59±0.48 g/dL，P = 0.006；3.93±0.28 vs. 3.73±0.29 g/dL，P<0.001）。转换为OL-HDF的患者中，血红蛋白和血清白蛋白水平显著升高（10.46±1.03 vs. 11.08±0.82 g/dL，P = 0.001；3.73±0.29 vs. 3.87±0.30 g/dL，P = 0.001）。24个月后标准化蛋白分解代谢率下降，但变化不显著（1.07±0.25 vs. 1.03±0.21 g/kg/天，P = 0.433）。虽然转换为HDF治疗的患者促红细胞生成素剂量更低，但差异不显著（-115.7±189.7 vs. -170.5±257.1，P = 0.206）。
超过12个月的OL-HDF治疗对贫血和营养状况无有害影响。
