Department of Renal Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-Ku, Hiroshima, 730-8655, Japan.
Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
J Artif Organs. 2024 Mar;27(1):48-56. doi: 10.1007/s10047-023-01391-2. Epub 2023 Apr 3.
Online hemodiafiltration (OL-HDF) is a treatment modality using diffusion and ultrafiltration. There are two types of dilution methods in OL-HDF: pre-dilution, which is commonly provided in Japan, and post-dilution, which is commonly provided in Europe. The optimal OL-HDF method for individual patients is not well studied. In this study, we compared the clinical symptoms, laboratory data, spent dialysate, and adverse events of pre- and post-dilution OL-HDF. We conducted a prospective study of 20 patients who underwent OL-HDF between January 1, 2019 and October 30, 2019. Their clinical symptoms and dialysis efficacy were evaluated. All patients underwent OL-HDF every 3 months in the following sequence: first pre-dilution, post-dilution, and second pre-dilution. We evaluated 18 patients for the clinical study and 6 for the spent dialysate study. No significant differences in spent dialysates regarding small and large solutes, blood pressure, recovery time, and clinical symptoms were observed between the pre- and post-dilution methods. However, the serum α1-microglobulin level in post-dilution OL-HDF was lower than that in pre-dilution OL-HDF (first pre-dilution: 124.8 ± 14.3 mg/L; post-dilution: 116.6 ± 13.9 mg/L; second pre-dilution: 125.8 ± 13.0 mg/L; first pre-dilution vs. post-dilution, post-dilution vs. second pre-dilution, and first pre-dilution vs. second pre-dilution: p = 0.001, p < 0.001, and p = 1.000, respectively). The most common adverse event was an increase in transmembrane pressure in the post-dilution period. Compared to pre-dilution, the post-dilution method decreased the α1-microglobulin level; however, there were no significant differences in clinical symptoms or laboratory data.
在线血液透析滤过（OL-HDF）是一种使用扩散和超滤的治疗方式。OL-HDF 有两种稀释方法：预稀释，在日本常用；后稀释，在欧洲常用。针对个体患者的最佳 OL-HDF 方法尚未得到充分研究。在这项研究中，我们比较了预稀释和后稀释 OL-HDF 的临床症状、实验室数据、消耗透析液和不良事件。我们进行了一项前瞻性研究，纳入了 2019 年 1 月 1 日至 2019 年 10 月 30 日期间接受 OL-HDF 的 20 名患者。评估了他们的临床症状和透析效果。所有患者每 3 个月按照以下顺序进行 OL-HDF：先预稀释、后稀释、再预稀释。我们对 18 名患者进行了临床研究，对 6 名患者进行了消耗透析液研究。预稀释和后稀释方法在小、大分子溶质、血压、恢复时间和临床症状方面的消耗透析液无显著差异。然而，后稀释 OL-HDF 中的血清α1-微球蛋白水平低于预稀释 OL-HDF（第一次预稀释：124.8±14.3mg/L；后稀释：116.6±13.9mg/L；第二次预稀释：125.8±13.0mg/L；第一次预稀释 vs. 后稀释，后稀释 vs. 第二次预稀释，第一次预稀释 vs. 第二次预稀释：p=0.001，p<0.001，p=1.000）。最常见的不良事件是后稀释期跨膜压升高。与预稀释相比，后稀释法降低了α1-微球蛋白水平；然而，在临床症状或实验室数据方面没有显著差异。
