内源性回输的高通量血液滤过治疗尿毒症瘙痒的早期临床观察

Early clinical observation of supra-hemodiafiltration with endogenous reinfusion in the treatment of uremic pruritus.

作者信息

Zha Fei, Li Wenwen, Shi Chunhua, Deng Yanyan, Shen Jianming

机构信息

Department of Nephrology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.

出版信息

Artif Organs. 2023 Sep;47(9):1503-1513. doi: 10.1111/aor.14552. Epub 2023 May 14.

DOI:10.1111/aor.14552

PMID:37083002

Abstract

BACKGROUND

To evaluate the clinical efficacy of supra-hemodiafiltration with endogenous reinfusion (Supra-HFR) for pruritus in uremic maintenance hemodialysis (HD) patients and explore the possible mechanism.

METHODS

This study prospectively included 60 patients with uremia who underwent maintenance hemodialysis and developed pruritus. Patients were randomly divided into a study group (30 cases) and a control group (30 cases). Patients in the study group underwent dialysis once a week with Supra-HFR and twice a week with HD. The group received HD dialysis 3 times a week. Visual analog scales (VAS) scores, 5-D itch scale scores, and 12-Item Pruritus Severity Scale (12-PSS) were used to evaluate the itching degree of patients. Quality of life was assessed using KDTA and SF-36 scores. Blood levels of hypersensitive C-reactive protein, calcium ion (Ca2+), phosphorus ion (P ), free parathyroid hormone (iPTH), and β2-microglobulin (β2-MG) were compared between the two groups before treatment and at follow-up 24 weeks after treatment.

RESULTS

Before treatment, there was no significant difference in VAS, 5-D itch scale, and 12-PSS score between the study group and the control group (all p > 0.05). After 24 weeks of treatment, the VAS score of the study group (2.82 ± 0.91) was significantly lower than that of the control group (7.47 ± 1.32, p < 0.001), the 5-D itch scale score of the study group (9.47 ± 2.34) was significantly lower than that of the control group (18.53 ± 4.02, p < 0.001), the 12-PSS score of the study group (11.20 ± 1.81) was significantly lower than that of the control group (16.47 ± 2.09, p < 0.001). KDTA of the study group (64.17 ± 8.07 vs. 47.83 ± 13.46, p < 0.001) and SF-36 scores (65.37 ± 6.28 vs. 55.90 ± 14.28, p = 0.002) were significantly higher than that in the control group. The levels of hs-CRP, P , iPTH, and β2-MG in the study group after treatment were lower than those before treatment, and lower than those in the control group after treatment (all p < 0.05).

CONCLUSIONS

The Supra-HFR can effectively reduce the itching symptoms of uremia patients and improve their quality of life.

摘要

背景

评估内源性再循环的高通量血液滤过（Supra-HFR）对尿毒症维持性血液透析（HD）患者瘙痒的临床疗效，并探讨其可能机制。

方法

本研究前瞻性纳入60例接受维持性血液透析且出现瘙痒的尿毒症患者。患者随机分为研究组（30例）和对照组（30例）。研究组患者每周进行1次Supra-HFR透析和2次HD透析。对照组每周进行3次HD透析。采用视觉模拟量表（VAS）评分、5-D瘙痒量表评分和12项瘙痒严重程度量表（12-PSS）评估患者的瘙痒程度。使用KDTA和SF-36评分评估生活质量。比较两组治疗前及治疗后24周随访时超敏C反应蛋白、钙离子（Ca2+）、磷离子（P）、游离甲状旁腺激素（iPTH）和β2-微球蛋白（β2-MG）的血药浓度。

结果

治疗前，研究组与对照组的VAS、5-D瘙痒量表和12-PSS评分无显著差异（均p>0.05）。治疗24周后，研究组的VAS评分（2.82±0.91）显著低于对照组（7.47±1.32，p<0.001），研究组的5-D瘙痒量表评分（9.47±2.34）显著低于对照组（18.53±4.02，p<0.001），研究组的12-PSS评分（11.20±1.81）显著低于对照组（16.47±2.09，p<0.001）。研究组的KDTA（64.17±8.07 vs. 47.83±13.46，p<0.001）和SF-36评分（65.37±6.28 vs. 55.90±14.28，p=0.002）显著高于对照组。研究组治疗后的hs-CRP、P、iPTH和β2-MG水平低于治疗前，且低于对照组治疗后（均p<0.05）。