Influence ofhigh flux dialysis on homocysteine levels and major cardiovascular events / 实用医学杂志

Objective To observe the influence of highflux hemodialysis(HFD)on homocysteine(Hcy) level and major cardiovascular events of maintenance hemodialysis (MHD) patients. Methods Patients eligible for inclusion were randomly divided into HFD group and low flux hemodialysis(HD)group with 30 cases in each group. Patient′s serum homocysteine (Hcy),major cardiovascular events and various clinical indicators were observed for 12 months then the data were analyzed. Results Hcy baseline levels in 2 groups(21.02 ± 11.79 mmol/L vs. 19.86 ± 6.97 mmol/L)indicated no significant difference(P = 0.162)before hemodialysis but Hcy levels had significant difference(20.29 ± 11.45 mmol/L vs. 24.57 ± 13.23 mmol/L),(P=0.045)after 12-month observation. There was lower incidence of major cardiovascular events in HFD when compared to that in HD group (10.0% vs. 33.3%) which showed significantly statistical difference (P=0.034),and there was no mortality in HFD group but 1 case of death in HD group. All-cause mortality in 2 groups showed no significant difference (P > 0.05). Conclusion Long-term HFD treatment significantly reduces Hcy levels and the incidence of major cardiovascular events of MHD patients

Clinical analysis on influence of HFHD and HFD on dialysis effect in patients with end-stage renal disease / 重庆医学

Objective To explore the influence of high flux hemodialysis (HFHD) and hemodialysis filtration (HDF) on the dialysis effect and patients mortality in the patients with end-stage renal disease(ESRD).Methods One hundred and twenty-two patients with ESRD in our hospitals were selected and respectively adopted HFHD (HFHD group,62 cases) and HDF (HDF group,60 cases) for conducting the dialysis therapy.The serum indexes before and after treatment were detected and compared between the two groups.Results Compared with before treatment,the level of blood urea nitrogen (BUN),blood uric acid (BUA),serum creatinine (Scr),blood phosphorus (P),parathyroid hormone (PTH),β2 microglobulin (β2-MG) and cysteine protease inhibitors (Cys-C) after treatment in the two groups were significantly decreased(P＜0.05).The clearance rates of P,PTH and Cys-C in the HFHD group were significantly higher than those in the HDF group(t=2.479,t=1.834,t=1.512,P＜0.05).The mortality after an average follow-up of (12.2 ± 3.7) months had statistical difference between the two groups,the mortality rate in the HDF group was significantly higher than that in the HFHD group (P＜ 0.05).The multivariate Cox regression analysis results showed that the HFHD was an important factor affecting death in ESRD patient (HR =0.50,95 ％ CI:0.33-0.84,P =0.009).Conclusion HFHD has more significant effect for clearing P,PTH,β2-MG and Cys-C than HDF in ESRD patients,moreover can reduces their mortality.

Effects of different hemodialysis ways on insulin resistance in non-diabetic renal disease patients with maintenance hemodialysis / 重庆医学

Objective To explore the effects of different hemodialysis ways on insulin resistance (IR) in non-diabetic renal disease patients with maintenance hemodialysis.Methods A total of 101 cases of non-diabetic renal disease patients with maintenance hemodialysis in Xuzhou Central Hospital from January 2014 to January 2015 were selected and divided into three groups:high-flux hemodialysis (HFHD) group,low-flux hemodialysis (LFHD) group and hemodialysis filtration (HDF) group.Patients in the three study groups were treated with HFHD,LFHD and HDF,respectively.After 6 months of hemodialysis treatment,clinical data and biochemical indicators were compared among the three groups,and Pearson correlation analysis and multivariate logistic regression analysis were used to explore the correlated factors of homeostasis model insulin resistance index (HOMA-IR).Results The levels of parathyroid hormone (PTH) in the HDF group and HFHD group were significantly lower than that in the LFHD group (P＜0.05),while the urea clearance index (Kt/V) values were significantly higher than that in the LFHD group (P＜ 0.05).The β2-microglobulin (β2-MG),fasting insulin (FINS) levels and HOMR-IR in the HDL group were significantly lower than those in the HFHD group and LFHD group (P＜0.05),and β2-MG clearance rate (β2-MGCR) in the HDF group was significantly higher than that in the HFHD group and LFHD group (P＜0.001).Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI (r=0.346,P=0.014),and was negatively correlated with β2-MGCR and HDL-C (r=-0.412,P=0.002;r=-0.204,P=0.042).Multivariate logistic regression analysis showed that BMI and HDF were independent factors affecting HOMA-IR values (OR=1.538,95％CI 1.364-1.759,P=0.021;OR=0.137,95％CI 0.045-0.632,P=0.012).Conclusion Compared with HFHD and LFHD,HDF can alleviate IR in non-diabetic renal disease patients with maintenance hemodialysis,which is of great significance for clinical treatment.

Effects of different hemodialysis ways on insulin resistance in non-diabetic renal disease patients with maintenance hemodialysis / 重庆医学

Objective To explore the effects of different hemodialysis ways on insulin resistance (IR) in non-diabetic renal disease patients with maintenance hemodialysis.Methods A total of 101 cases of non-diabetic renal disease patients with maintenance hemodialysis in Xuzhou Central Hospital from January 2014 to January 2015 were selected and divided into three groups:high-flux hemodialysis (HFHD) group,low-flux hemodialysis (LFHD) group and hemodialysis filtration (HDF) group.Patients in the three study groups were treated with HFHD,LFHD and HDF,respectively.After 6 months of hemodialysis treatment,clinical data and biochemical indicators were compared among the three groups,and Pearson correlation analysis and multivariate logistic regression analysis were used to explore the correlated factors of homeostasis model insulin resistance index (HOMA-IR).Results The levels of parathyroid hormone (PTH) in the HDF group and HFHD group were significantly lower than that in the LFHD group (P＜0.05),while the urea clearance index (Kt/V) values were significantly higher than that in the LFHD group (P＜ 0.05).The β2-microglobulin (β2-MG),fasting insulin (FINS) levels and HOMR-IR in the HDL group were significantly lower than those in the HFHD group and LFHD group (P＜0.05),and β2-MG clearance rate (β2-MGCR) in the HDF group was significantly higher than that in the HFHD group and LFHD group (P＜0.001).Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI (r=0.346,P=0.014),and was negatively correlated with β2-MGCR and HDL-C (r=-0.412,P=0.002;r=-0.204,P=0.042).Multivariate logistic regression analysis showed that BMI and HDF were independent factors affecting HOMA-IR values (OR=1.538,95％CI 1.364-1.759,P=0.021;OR=0.137,95％CI 0.045-0.632,P=0.012).Conclusion Compared with HFHD and LFHD,HDF can alleviate IR in non-diabetic renal disease patients with maintenance hemodialysis,which is of great significance for clinical treatment.

Prognostic effect of high-flux hemodialysis in patients with chronic kidney disease

We investigated the prognostic effects of high-flux hemodialysis (HFHD) and low-flux hemodialysis (LFHD) in patients with chronic kidney disease (CKD). Both an electronic and a manual search were performed based on our rigorous inclusion and exclusion criteria to retrieve high-quality, relevant clinical studies from various scientific literature databases. Comprehensive meta-analysis 2.0 (CMA 2.0) was used for the quantitative analysis. We initially retrieved 227 studies from the database search. Following a multi-step screening process, eight high-quality studies were selected for our meta-analysis. These eight studies included 4967 patients with CKD (2416 patients in the HFHD group, 2551 patients in the LFHD group). The results of our meta-analysis showed that the all-cause death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.704, 95%CI=0.533-0.929, P=0.013). Additionally, the cardiovascular death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.731, 95%CI=0.616-0.866, P<0.001). The results of this meta-analysis clearly showed that HFHD decreases all-cause death and cardiovascular death rates in patients with CKD and that HFHD can therefore be implemented as one of the first therapy choices for CKD.

Effect of high flux hemodialysis combined with artificial kidney on fibroblast growth factor-23 / 中国中西医结合急救杂志

Objective To observe the effect of high flux hemodialysis (HFHD) combined with artificial kidney on fibroblast growth factor-23 (FGF-23) in patients with maintenance hemodialysis (MHD). Methods Eighty cases who regularly carried out long-term HFHD in nephrology blood purification center of NO.85 Hospital of PLA were enrolled. All the patients firstly received HFHD alone for 1 month, and then according to random principle, they could receive HFHD followed by hemoperfusion (HP) for treatment (HFHD+HP group) or HP followed by HFHD for treatment (HP+HFHD group). These two types of treatment were respectively carried out for 3 months, and then exchanged to proceed the procedure, the interval of exchange being 1 month (in this month, the two groups of patients all underwent simple HFHD treatment). The therapeutic course was 8 months including 2 cycles. The serum samples were taken from patients undergoing simple HFHD before and after the first month of blood purification, and patients in HFHD+HP group and HP+HFHD group before and after the last month for determination of serum creatinine (SCr), calcium, phosphorus, parathyroid hormone (iPTH), FGF-23 levels. Results The SCr level in HFHD + HP group before hemodialysis was significantly lower than that in simple HFHD group (μmol/L:773.45±212.23 vs. 803.27±192.47, P0.05). After hemodialysis, the serum iPTH, FGF-23 were dropped significantly in HFHD + HP and HP + HFHD groups compared with those in simple HFHD group (P 0.05). But the levels of serum phosphorus, iPTH, and FGF-23 in HFHD+HP group were significantly lower than those of HP+HFHD group [serum phosphorus (mmol/L):1.47±0.22 vs. 1.60±0.23, iPTH (μg/L):490.12±145.23 vs. 516.34±165.75, FGF-23 (μg/L): 802.11±92.58 vs. 822.39±107.23, P < 0.05 or P < 0.01]. Conclusions In the aspect of elimination of large and medium sized molecules, the effect of combined artificial kidney is much better than that of simple HFHD. The rates of toxin elimination in different types of combined artificial kidney treatment are different, and the HFHD+HP type has greater effect than HP+HFHD type on elimination of toxins with large or medium sized molecules such as iPTH, FGF-23, etc.

Research on high flux hemodialysis in treatment of severe renal failure / 中国医学装备

Objective:To investigate the high flux hemodialysis (HFD) on the application effect of severe renal failure patients the level of inflammatory factors, blood lipid and protein. Methods:In 2012 January to 2013 December was performed in 80 patients with severe renal failure in the treatment of MHD, were randomly divided into two groups, study group 40 cases by high-throughput MHD treatment, 40 cases in the control group using conventional MHD treatment. Results: There was no significant difference in two groups before treatment of various inflammatory factors difference (P>0.05); after the treatment, two groups of patients with TNF- α, IL-6 and hs-CRP levels were significantly lower(t=14.138, t=5.891, t=11.093;P0.05);after the treatment, patients in study group were TP, ALB andβ2-M compared with those before treatment were significantly improved, ALB of control group had obvious improvement than before treatment (P0.05);after the treatment, patients in study group TC and TG compared with those before treatment were significantly improved after treatment, and compared with the control group index improved significantly (t=2.963, t=6.914; P<0.01). Conclusion:High throughput MHD therapy based on conventional MHD filtration of small molecular toxin traits on patients with severe renal failure, increase the filtration range, clear promote inflammatory molecules, plasma proteins, blood lipid molecules, such as in large molecules, so as to achieve a better therapeutic effect.

Effects of high-flux hemodialysis on fibroblast growth factor-23 and its clinical significance / 中华肾脏病杂志

Objective To investigate the effects of high-flux hemodialysis (HFD) on fibroblast growth factor-23 (FGF-23) levels in maintenance hemodialysis (MHD) patients and its clinical significance.Methods Sixty uremia patients were divided into HFD group and hemodialysis (HD)group and observed for 12 months.Flow mediated dilation (FMD),cardiac ultrasonography,levels of FGF-23,serum phosphorus,serum calcium,25-(OH)D3,parathyroid hormone (PTH),homocysteine (Hcy) and interleukin-6 (IL-6) were tested in all patients before and after treatment.The correlation of above indexes were analyzed.Results No statistical difference were found in primary disease,age and duration of dialysis in two groups.The levels of FGF-23 [(56.07±26.63) vs (85.53±40.54) ng/L,P ＜0.01],IL-6 [(3.37±2.48) vs (5.59±2.53) ng/L,P ＜ 0.05] and Hcy [(21.13±6.95) vs (29.40±11.66) μmol/L,P ＜ 0.05] decreased and FMD,25-(OH)D3 [(27.3± 10.26) vs (23.15± 10.73) μg/L,P ＜ 0.05] increased significantly after the treatment of HFD.There were no significant changes in the HD group.The baseline FMD was negatively correlated with FGF-23 (r =-0.413,P ＜ 0.05) and Hcy (r =-0.301,P ＜0.05).The baseline LVMI was correlated with FGF-23 (r =0.464 P ＜ 0.05).After one year's trearmeat of HFD,the changes of FMD(/△ FMD) was negatively correlated with the changes of FGF-23 (/△ FGF-23)(r =-0.347,P ＜ 0.05).Conclusions HFD can improve FMD and decrease FGF-23 levels.The improvement of FMD may be related to the decreased level of FGF-23.The effect of FGF-23 on FMD should be independent of serum phosphate.

Corrección de la hiperfosforemia en pacientes con enfermedades renales crónicas tratados con hemodiálisis de alto flujo de larga duración / Correction of hyperphosphoremia in patients suffering chronic renal diseases and treated with long duration and high flux dialysis

Introducción: la hemodiálisis de alto flujo origina mayor remoción de moléculas grandes y pequeñas, por lo que incrementa su aclaramiento y se obtiene una mejoría ostensible en las personas tratadas. Teniendo en cuenta que la remoción del fósforo depende de su cinética, esta técnica permite lograr su corrección, más si la combinamos con una mayor duración y frecuencia de las sesiones de diálisis. Objetivo: evaluar la corrección de la hiperfosforemia con la hemodiálisis de alto flujo y de larga duración. Métodos: se realizó un estudio de intervención experimental en 2 grupos: estudio y control, elegidos por el método aleatorio simple 12 pacientes que tenían elevadas las cifras de fósforo. El grupo I recibió hemodiálisis de alto flujo de larga duración 18 h semanales utilizando dializadores con membrana de polisulfona de alto flujo y el grupo II, hemodiálisis convencional de bajo flujo 12 h semanales de tratamiento. Ambos con seguimiento clínico-humoral mensual. Fueron analizadas las variables de respuesta primaria y secundaria dadas por los niveles de fósforo, calcio, producto fosfocálcico, KT/V, albúmina, hemoglobina y morbilidad; los datos fueron procesados mediante el paquete estadístico SPSS versión 15.0. Resultados: En el grupo estudio hubo una disminución del fósforo sérico en 0,36 mmol/L, el calcio y el producto fosfocálcico disminuyeron en el tiempo en 9,2 porciento y 23,90 por ciento, respectivamente, al final del estudio. No existió correlación entre el tiempo de tratamiento (diálisis) y la hiperfosforemia, con una correlación lineal no paramétrica de Spearman de -0,09 y sin significación estadística. El 66,7 por ciento presentó calambres y el 50 porciento hipotensión como morbilidad. Conclusión: la hemodiálisis de alto flujo y larga duración disminuye los niveles séricos de fósforo y mejora los niveles de albúmina, calcio, metabolismo fosfocálcico y KT/V en los pacientes en hemodiálisis

Introduction: high flux hemodialysis causes major removal of big and small molecules, so the clearing increases and the treated people remarkably improves. Taking into account that excretion of phosphorus depends on its kinetics, this technique allows correcting it, mainly if combined with long duration and high frequency dialysis. Objective: to evaluate the correction of hyperphosphoremia based on long duration high flux hemodialysis. Methods: an experimental intervention study was conducted in two groups, namely, the study and the control groups in which 12 patients, who were selected by the simple random method, were distributed. They presented with high phosphorus content figures. Group I was treated with long duration high flux hemodialysis for 18 hours every week by using high flux polysulphone membrane dialyzers. Group II underwent conventional low flux hemodialysis for 12 hours a week. Both groups were clinically and humorally followed-up monthly. The primary and secondary response variables depending on the phosphorous, calcium, calcium phosphate product, KT/V, albumin, hemoglobin and morbidity levels were analyzed. Data were processed using SPPS statistical package, 15.0 version. Results: the study group lowered the serum phosphorus by 0.36 mmol/L, calcium and calcium phosphate product decreased by 9.2 percent and 23.90 percent respectively at the end of the study. There was no correlation between the length of treatment (dialysis) and hyperphosphoremia; Spearman's non-parametric linear correlation was -0.09 and there was no statistical significance. Of the patients, 66.7 percent had cramps and 50 percent had hypotension as morbidity. Conclusions: long duration high flux hemodialysis reduces the serum phosphorus levels and improves albumin, calcium, calcium phosphate product metabolism and KT/V in patients on hemodialysis

Solute clearance characteristics of REXEEDTM series dialyzer during high-flux dialysis / 上海第二医科大学学报

Objective To evaluate the solute clearance characteristics of REXEEDTM series dialyzers during high-flux dialysis, and explore the care characteristics. Methods A randomized crossover study of 3×3 Latin square was designed based on different dialyzers. Eighteen patients with regular hemodialysis underwent dialysis with REXEEDTM-15AC dialyzer, REXEEDTM-15UC dialyzer and controlled APS-15U dialyzer, respectively. Blood samples were obtained from the blood flow entrance and exit of dialyzers, levels of urea nitrogen, creatinine, phosphate and β2-microglobulin were detected, and solute clearance rates were calculated. Before and after the third dialysis with each dialyzer, blood samples were obtained to measure the levels of urea nitrogen and creatinine, and the rates of decrease were calculated. The vital signs of each patient were intensively observed, and the venous pressure and transmembrane pressure were monitored from the dialyzers. Results The urea nitrogen clearance rates of REXEEDTM-15AC dialyzer and REXEEDTM-15UC dialyzer were significantly higher than that of APS-15U dialyzer (P<0.05). The creatinine clearance rate of REXEEDTM-15AC dialyzer was significantly higher than that of APS-15U dialyzer(P<0.05). There was no significant difference in the rate of decrease in blood urea nitrogen among different dialyzers of the same patient(>65 % for all patients). The vital signs were stable with no adverse events during dialysis, and there was no abnormal findings in laboratory security parameters. Conclusion REXEEDTM series dialyzers are effective and safe for clinical application. Great importance should be attached to the complaints from patients during dialysis. For those with less ultrafiltration, fluid as well as uhrafiltration should be supplemented to increase the transmembrane pressure.