Aterini Lorenzo, Aterini Stefano, Vadalà Barbara, Ravaglia Francesco, Balboni Fiamma, Gallo Marco
Nephrology, School of Human Health Sciences, Azienda Ospedaliera Universitaria (AOU) Meyer Children Hospital, University of Florence, Florence, ITA.
Hemodialysis Centre, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, ITA.
Cureus. 2024 Jul 11;16(7):e64323. doi: 10.7759/cureus.64323. eCollection 2024 Jul.
Expanded hemodialysis (HDx), being based on medium cut-off (MCO) membranes, improves the removal of medium molecule uremic toxins. HDx efficacy has been proven with blood flow rates (Qb) of 350-400 ml/min, while low Qb have only been assessed in single sessions. We evaluated the effectiveness of HDx in patients with tunneled central venous catheters (CVCs) and low Qb over six months, comparing it with high-flux hemodialysis (HF-HD).
The study included 10 patients with a mean age of 79±12 years and mean Qb of 237 ± 12 ml/min. Reduction ratios (RRs) and predialysis serum levels were measured for β2-microglobulin (B2M), free κ and λ light chains (FLC), prolactin (PRL), interleukin-6 (IL-6), albumin, and urea after HF-HD and at one, three, and six months of HDx. Erythropoiesis-stimulating agent (ESA) resistance index (ERI) was also evaluated.
B2M, κ-FLC, λ-FLC, and PRL RRs were significantly higher with HDx. IL-6, albumin, and urea RRs did not show a statistical difference between the two treatments. Predialysis B2M concentrations were significantly lower after three and six months of HDx, matching up to increased B2M clearance (spKt/V). A decrease in albumin concentrations was observed, with median levels significantly reduced at months seven and eight (35.3 and 35.5 g/L, respectively) but recovering afterwards. ERI was significantly lower during HDx, reaching a 30% reduction at month six.
HDx was feasible, safe, and superior to HF-HD in patients with low Qb rates of tunneled dialysis catheters. The present data expand options for HDx prescription, with particular regard for patients who cannot achieve high convective volumes due to inadequate vascular access.
基于中截留量（MCO）膜的扩展血液透析（HDx）可改善中分子尿毒症毒素的清除。HDx的疗效已在血流量（Qb）为350 - 400 ml/min时得到证实，而低Qb仅在单次治疗中进行过评估。我们评估了在六个月内，HDx对带隧道中心静脉导管（CVC）且Qb较低的患者的有效性，并与高通量血液透析（HF - HD）进行比较。
该研究纳入了10名平均年龄为79±12岁、平均Qb为237±12 ml/min的患者。在HF - HD后以及HDx治疗1个月、3个月和6个月时，测量β2 - 微球蛋白（B2M）、游离κ和λ轻链（FLC）、催乳素（PRL）、白细胞介素 - 6（IL - 6）、白蛋白和尿素的清除率（RRs）以及透析前血清水平。还评估了促红细胞生成素（ESA）抵抗指数（ERI）。
HDx治疗时B2M、κ - FLC、λ - FLC和PRL的RRs显著更高。两种治疗方法的IL - 6、白蛋白和尿素RRs无统计学差异。HDx治疗3个月和6个月后，透析前B2M浓度显著降低，这与B2M清除率（spKt/V）增加相匹配。观察到白蛋白浓度下降，在第7个月和第8个月时中位数水平显著降低（分别为35.3和35.5 g/L），但随后恢复。HDx治疗期间ERI显著降低，在第6个月时降低了30%。
对于带隧道透析导管且Qb较低的患者，HDx可行、安全且优于HF - HD。目前的数据扩展了HDx处方的选择，尤其适用于因血管通路不足而无法实现高对流容量的患者。
