不同组合透析方案对维持性血液透析患者相关并发症的影响
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摘要
目的观察不同组合透析方案治疗对维持性血液透析(MHD)患者生化指标及相关并发症的疗效。方法选择泰州市人民医院血液净化中心MHD患者80例,治疗方案均为血液透析(HD)(2次/周)、血液透析滤过(HDF)(1次/周)、血液透析联合血液灌流(HD+HP)(1次/2周)的组合式透析方案。随机分为A、B两组,各40例,A组继续使用原治疗方案;B组将透析治疗方案改为HD(2次/周)、HDF(1次/周)、HDF+HP(1次/2周),观察期为3个月。记录患者入组时及治疗3个月后血压控制情况并采血检测相关指标,记录透析相关并发症等,同时统计治疗期间的费用情况。结果 A组与B组入组时各项指标比较无统计学差异(P>0.05)。治疗3个月后发现:①B组收缩压、舒张压较A组明显下降,差异有统计学意义(P<0.05);②与A组比较,B组甲状旁腺素、血磷、β_2微球蛋白均显著下降(P<0.05),血红蛋白显著上升(P<0.05),皮肤瘙痒明显改善(P<0.05);③B组C-反应蛋白较A组下降,差异有统计学意义(P<0.05);④A组与B组比较,血浆白蛋白水平、透析相关并发症发生率及总治疗费用无显著差异(P>0.05)。结论 HD、HDF、HDF+HP组合透析方案能更好清除体内代谢产物、尿毒症毒素,纠正肾性贫血及慢性肾脏病矿物质和骨异常,改善机体内微炎症状态、营养状况及皮肤瘙痒症状,血压控制更理想。故该方案能更好的改善MHD患者远期并发症,且相对不增加治疗费用,有推广价值。
Objective To observe the efficacy of hemodiafiltration combined with hemoperfusion( HDF + HP) for treatment of complications associated with hemodialysis in patents with maintenance hemodialysis( M HD). M ethods A total of 8 0 patients with M HD in our center were selected. The treatment regimens were all a combined dialysis scheme,including hemodialysis( HD,twice a week),hemodiafiltration( HDF,once a week) and hemodialysis combined with hemoperfusion( HD + HP,fortnightly). The subjects were randomly divided equally into two groups,named group A and group B. Group A continued the original regimen The regimen for group B was adjusted to HD( twice a week),HDF( once a week)and HDF + HP( fortnightly),with an observation period of 3 months. Blood samples were selected to detect the related indices, and to record dialysis-associated complications; meanwhile,the expense during the treatment was summarized. Results There was no significant difference in various indexes before grouping between group A and group B( P > 0. 0 5). During the observation,there was no significant difference in the incidence of dialysis related complications( P > 0. 0 5). After 3 months of observation,we found that:( 1) systolic blood pressure and diastolic blood pressure in group B were significantly lower than those in group A,with difference of statistical significance( P < 0. 0 5).( 2) Compared with group A,the levels of iPTH,phosphorus and β-2 microglobulin in group B were significantly decreased( P <0. 0 5),Hb significantly increased( P < 0. 0 5),and skin pruritus improved significantly( P< 0. 0 5).( 3) CRP in group B was lower than that in group A( P < 0. 0 5).( 4) There was no significant difference in plasma albumin level and total treatment cost between group A and B group( P > 0. 0 5). Conclusions HDF + HP can better remove metabolic products and uremia toxin from the body,rectify renal anemia and chronic kidney disease mineral and bone disorder( CKD-M BD),improve the state of microinflammation,nutritional status and skin pruritus,and control blood pressure more ideally. Therefore,HDF + HP can better improve the long-term complications in M HD patients,does not relatively increase the cost of treatment and so is worth popularizing.
Objective To observe the efficacy of hemodiafiltration combined with hemoperfusion( HDF + HP) for treatment of complications associated with hemodialysis in patents with maintenance hemodialysis( M HD). M ethods A total of 8 0 patients with M HD in our center were selected. The treatment regimens were all a combined dialysis scheme,including hemodialysis( HD,twice a week),hemodiafiltration( HDF,once a week) and hemodialysis combined with hemoperfusion( HD + HP,fortnightly). The subjects were randomly divided equally into two groups,named group A and group B. Group A continued the original regimen The regimen for group B was adjusted to HD( twice a week),HDF( once a week)and HDF + HP( fortnightly),with an observation period of 3 months. Blood samples were selected to detect the related indices, and to record dialysis-associated complications; meanwhile,the expense during the treatment was summarized. Results There was no significant difference in various indexes before grouping between group A and group B( P > 0. 0 5). During the observation,there was no significant difference in the incidence of dialysis related complications( P > 0. 0 5). After 3 months of observation,we found that:( 1) systolic blood pressure and diastolic blood pressure in group B were significantly lower than those in group A,with difference of statistical significance( P < 0. 0 5).( 2) Compared with group A,the levels of iPTH,phosphorus and β-2 microglobulin in group B were significantly decreased( P <0. 0 5),Hb significantly increased( P < 0. 0 5),and skin pruritus improved significantly( P< 0. 0 5).( 3) CRP in group B was lower than that in group A( P < 0. 0 5).( 4) There was no significant difference in plasma albumin level and total treatment cost between group A and B group( P > 0. 0 5). Conclusions HDF + HP can better remove metabolic products and uremia toxin from the body,rectify renal anemia and chronic kidney disease mineral and bone disorder( CKD-M BD),improve the state of microinflammation,nutritional status and skin pruritus,and control blood pressure more ideally. Therefore,HDF + HP can better improve the long-term complications in M HD patients,does not relatively increase the cost of treatment and so is worth popularizing.
引文
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[8] Rodríguez M,Rodríguez-Ortiz ME.Advances in pharmacotherapy for secondary hyperparathyroidism[J].Expert Opin Pharmacother,2015,16(11):1703-1716.
[9] Komaba h,Taniguchi m,Wada a,et al.Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism[J].Kidney Int,2015,88(2):350-359.
[10] Brunerová L,Ronová P,Vere?ová J,et al.Osteoporosis and impaired trabecular bone score in hemodialysis patients[J].Kidney Blood Press Res,2016,41(3):345-354.
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[13] Kim HW,Yang HN,Kim MG,et al.Microinflammation in hemodialysis patients is associated with increased CD14CD16(+) pro-inflammatory monocytes:possible modification by on-line hemodiafiltration[J].Blood Purif,2011,31(4):281-288.
[14] Ronco C.Hemodiafiltration:technical and clinical issues[J].Blood Purif,2015,40(Suppl 1):2-11.
[15] Romaschin AD,Obiezu-Forster CV,Shoji H,et al.Novel insights into the direct removal of endotoxin by polymyxin B hemoperfusion[J].Blood Purif,2017,44(3):193-197.
[2] Bovio G1,Esposito C,Montagna G,et al.Inadequate macronutrient and micronutrient intakes in hemodialysis and peritoneal dialysis patients:data from a seven-day weighed dietary record[J].Nephron,2016,133(4):253-260.
[3] Mastrangelo A,Paglialonga F,Edefonti A.Assessment of nutritional status in children with chronic kidney disease and on dialysis[J].Pediatr Nephrol,2014,29(8):1349-1358.
[4] Merino A,Nogueras S,Buendía P,et al.Microinflammation and endothelial damage in hem dialysis[J].Contrib Nephrol,2008,161:83-88.
[5] Basile C.Dialysis adequacy:the clinical illogicality of Kt/V urea[J].G Ital Nefrol,2011,28(2):147-151.
[6] Garlich FM,Goldman M,Pepe J,Hemodialysis clearance of glyphosate following a life-threatening ingestion of glyphosate-surfactant herbicide[J].Clin Toxicol (Phila),2014,52(1):66-71.
[7] Zumrutdal A.Role of β2-microglobulin in uremic patients may be greater than originally suspected[J].World J Nephrol,2015,4(1):98-104.
[8] Rodríguez M,Rodríguez-Ortiz ME.Advances in pharmacotherapy for secondary hyperparathyroidism[J].Expert Opin Pharmacother,2015,16(11):1703-1716.
[9] Komaba h,Taniguchi m,Wada a,et al.Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism[J].Kidney Int,2015,88(2):350-359.
[10] Brunerová L,Ronová P,Vere?ová J,et al.Osteoporosis and impaired trabecular bone score in hemodialysis patients[J].Kidney Blood Press Res,2016,41(3):345-354.
[11] Afsar B.The relationship between depressive symptoms and erythropoietin resistance in stable hemodialysis patients with adequate iron stores[J].Int J Artif Organs,2013,36(5):314-319.
[12] Schneider A1,Schneider MP,Scharnagl H,et al.Predicting erythropoietin resistance in hemodialysis patients with type 2 diabetes[J].BMC Nephrol,2013,14:67.
[13] Kim HW,Yang HN,Kim MG,et al.Microinflammation in hemodialysis patients is associated with increased CD14CD16(+) pro-inflammatory monocytes:possible modification by on-line hemodiafiltration[J].Blood Purif,2011,31(4):281-288.
[14] Ronco C.Hemodiafiltration:technical and clinical issues[J].Blood Purif,2015,40(Suppl 1):2-11.
[15] Romaschin AD,Obiezu-Forster CV,Shoji H,et al.Novel insights into the direct removal of endotoxin by polymyxin B hemoperfusion[J].Blood Purif,2017,44(3):193-197.