高通量血液透析联合血液透析滤过治疗终末期肾病的效果

doi:10.3760/cma.j.cn441417-20240924-05005

摘要/Abstract

摘要：

目的　探讨高通量血液透析联合血液透析滤过治疗终末期肾病的效果。方法　选取2020年1月至2023年1月西安高新医院收治的94例终末期肾病患者作为研究对象。采用随机数字表法，将患者分为对照组（47例）和观察组（47例）。对照组男27例，女20例；年龄（61.91±7.39）岁；体重指数（23.21±3.24）kg/m²；病程（3.85±0.68）年；原发疾病：慢性肾小球肾炎23例，糖尿病肾病14例；高血压性肾损害10例。观察组男25例，女22例；年龄（61.75±7.23）岁；体重指数（23.07±3.19）kg/m²；病程（3.77±0.59）年；原发疾病：慢性肾小球肾炎26例，糖尿病肾病13例；高血压性肾损害8例。对照组采用高通量血液透析治疗（4 h/次，每周3次），观察组在对照组基础上联合血液透析滤过治疗（4 h/次，每2周1次）。两组均连续治疗4个月。比较两组治疗前后炎症因子水平［肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、白细胞介素-6（IL-6）］、钙磷代谢情况（血钙、血磷）、肾功能［尿氮素（BUN）、肌酐（Scr）］、营养状况［前白蛋白（PA）、血红蛋白（Hb）、白蛋白（ALB）］。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　治疗后，观察组血清TNF-α、CRP、IL-6水平均低于对照组［（23.28±3.49）ng/L比（31.39±4.27）ng/L、（6.38±1.09）mg/L比（8.23±1.54）mg/L、（8.01±1.49）ng/L比（12.04±2.03）ng/L］（均P<0.05）；观察组血钙水平高于对照组［（2.35±0.34）mmol/L比（2.06±0.25）mmol/L］，血磷水平低于对照组［（1.30±0.11）mmol/L比（1.56±0.15）mmol/L］（均P<0.05）；观察组血清BUN、Scr水平均低于对照组［（14.85±2.12）mmol/L比（17.72±2.35）mmol/L、（301.24±29.89）μmmol/L比（440.34±37.78）μmmol/L］（均P<0.05）；观察组血清PA、Hb和ALB水平均高于对照组［（274.12±31.47）mg/L比（168.24±20.13）mg/L、（117.03±14.23）g/L比（99.78±10.16）g/L、（42.14±5.03）g/L比（36.02±4.19）g/L］（均P<0.05）。结论　高通量透析联合血液透析滤过治疗可降低终末期肾病患者炎症因子水平，改善钙磷代谢情况、肾功能和营养状况。

关键词:

高通量血液透析, 血液透析滤过, 终末期肾病, 肾功能, 炎症因子

Abstract:

Objective　To evaluate the impacts of high-flux hemodialysis combined with hemodiafiltration on renal function and inflammatory level in patients with end-stage renal disease. Methods　Ninety-four patients with end-stage renal disease admitted to Xi'an Hi-tech Hospital from January 2020 to January 2023 were selected as the study objects, and were divided into a control group (47 cases) and an observation group (47 cases) by the random number table method. The control group included 27 males and 20 females, aged (61.91±7.39) years, with a body mass index (BMI) of (23.21±3.24) kg/m² and a course of disease of (3.85±0.68) years, and the primary diseases were chronic glomerulonephritis in 23 cases, diabetic nephropathy in 14 cases, and hypertensive renal injury in 10 cases. The observation group included 25 males and 22 females, aged (61.75±7.23) years, with a BMI of (23.07±3.19) kg/m² and a course of disease of (3.77±0.59) years, and the primary diseases were chronic glomerulonephritis in 26 cases, diabetic nephropathy in 13 cases, and hypertensive renal injury in 8 cases. The control group was treated with high-flux hemodialysis (4 h/time, 3 times a week), and the observation group was combined with hemodiafiltration (4 h/time, once every 2 weeks). Both groups were treated continuously for 4 months. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6)], calcium and phosphorus metabolism (serum calcium and phosphorus), renal function [urinary nitrogen (BUN) and creatinine (Scr)], nutritional status [prealbumin (PA), hemoglobin (Hb), and albumin (ALB)] before and after treatment were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After treatment, the levels of TNF-α, CRP, and IL-6 in the observation group were lower than those in the control group [(23.28±3.49) ng/L vs. (31.39±4.27) ng/L, (6.38±1.09) mg/L vs. (8.23±1.54) mg/L, (8.01±1.49) ng/L vs. (12.04±2.03) ng/L] (all P<0.05); the serum calcium level of the observation group was higher than that of the control group [(2.35±0.34) mmol/L vs. (2.06±0.25) mmol/L], and the serum phosphorus level was lower than that of the control group [(1.30±0.11) mmol/L vs. (1.56±0.15) mmol/L] (both P<0.05); serum BUN and Scr levels in the observation group were lower than those in the control group [(14.85±2.12) mmol/L vs. (17.72±2.35) mmol/L, (301.24±29.89) μmmol/L vs. (440.34±37.78) μmmol/L] (both P<0.05); the levels of PA, Hb, and ALB in the observation group were higher than those in the control group [(274.12±31.47) mg/L vs. (168.24±20.13) mg/L, (117.03±14.23) g/L vs. (99.78±10.16) g/L, (42.14±5.03) g/L vs. (36.02±4.19) g/L] (all P<0.05). Conclusion　The combined treatment of high-flux hemodialysis and hemodiafiltration contributes to reducing inflammation level and improving renal function and nutritional status in patients with end-stage renal disease.

Key words:

High-flux hemodialysis, Hemodiafiltration, End-stage renal disease, Renal function, Inflammatory factors

权皎洁王小玲陈惠娟.

高通量血液透析联合血液透析滤过治疗终末期肾病的效果 [J]. 国际医药卫生导报, 2025, 31(5): 729-733.

Quan Jiaojie, Wang Xiaoling, Chen Huijuan.

Effect of high-flux hemodialysis combined with hemodiafiltration in patients with end-stage renal disease [J]. International Medicine and Health Guidance News, 2025, 31(5): 729-733.

参考文献

[1] 崔金锐,肖琦,柯键,等.老年终末期肾病患者共享决策体验质性研究的Meta整合[J].中华护理杂志,2022,57(7):863-871.DOI:10.3761/j.issn.0254-1769.2022.07.016.
[2] Yang T, Wei B, Liu J, et al. A landscape of metabolic variation among clinical outcomes of peritoneal dialysis in end-stage renal disease[J]. Clin Chim Acta, 2024, 555:117826. DOI: 10.1016/j.cca.2024.117826.
[3] 中华医学会肾脏病学分会专家组.终末期糖尿病肾脏病肾替代治疗的中国指南[J].中华肾脏病杂志,2022,38(1):62-75.DOI:10.3760/cma.j.cn441217-20210322-00012.
[4] 林兴芳,李斌,姬珊珊.碳酸司维拉姆联合高通量血液透析对尿毒症患者钙磷代谢及微炎症状态的影响[J].国际医药卫生导报,2020,26(3):326-328.DOI:10.3760/cma.j.issn.1007-1245.2020.03.010.
[5] Rambabova Bushljetik I, Trajceska L, Biljali S, et al. Efficacy of medium cut-off dialyzer and comparison with standard high-flux hemodialysis[J]. Blood Purif, 2021,50(4-5):492-498. DOI: 10.1159/000511983.
[6] 王璐,陶娇.两种血液透析滤过模式对维持性透析患者的疗效研究[J].吉林医学,2021,42(7):1637-1640.DOI:10.3969/j.issn.1004-0412.2021.07.035.
[7] 刘倩,蒲萌萌,杨凯,等.不同频率血液透析滤过联合高通量血液透析治疗尿毒症的效果分析及对预后的影响[J].中国现代医学杂志,2023,33(6):71-76.DOI:10.3969/j.issn.1005-8982.2023.06.013.
[8] Blankestijn PJ, Fischer KI, Barth C, et al. Benefits and harms of high-dose haemodiafiltration versus high-flux haemodialysis: the comparison of high-dose haemodiafiltration with high-flux haemodialysis (CONVINCE) trial protocol[J]. BMJ Open, 2020, 10(2):e033228. DOI: 10.1136/bmjopen-2019-033228.
[9] 黎磊石,刘志红.中国肾脏病学[M].北京:人民军医出版社,2008:640-645.
[10] Murea M, Flythe JE, Anjay R, et al. Kidney dysfunction requiring dialysis is a heterogeneous syndrome: we should treat it like one[J]. Curr Opin Nephrol Hypertens, 2022, 31(1):92-99. DOI: 10.1097/MNH.0000000000000754.
[11] 贾凤玉.重视终末期肾病血液透析患者血镁的变化[J].肾脏病与透析肾移植杂志,2023,32(3):281-285.DOI:10.3969/j.issn.1006-298X.2023.03.017.
[12] 姜晓岚,刘斌.高通量血液透析对维持性透析患者血清铁调素及低氧诱导因子的影响研究[J].中国血液净化,2023,22(2):81-85.DOI:10.3969/j.issn.1671-4091.2023.02.001.
[13] 谢庆磊,张留平,王越.高通量血液透析与血液透析滤过对老年透析病人生活质量的影响[J].实用老年医学,2023,37(7):719-722.DOI:10.3969/j.issn.1003-9198.2023. 07.017.
[14] 黄雯,唐熙,王兴纯.高通量血液透析联合血液透析滤过序贯治疗慢性肾衰竭的临床效果及对钙磷代谢、预后的影响[J].解放军医药杂志,2022,34(6):55-58.DOI:10.3969/j.issn.2095-140X.2022.06.013.
[15] Yu S, Yang H, Chen W, et al. Middle-size molecule clearance as measured by β2-microglobulin in high-flux versus low-flux dialysis and hemodiafiltration: a prospective randomized controlled trial[J]. Artif Organs, 2023, 47(1):38-46. DOI: 10.1111/aor.14423.
[16] Wolley MJ, Hutchison CA. Large uremic toxins: an unsolved problem in end-stage kidney disease[J]. Nephrol Dial Transplant, 2018, 33(suppl_3):iii6-iii11. DOI: 10.1093/ndt/gfy179.
[17] Lang T, Zawada AM, Theis L, et al. Hemodiafiltration: technical and medical insights[J]. Bioengineering (Basel), 2023, 10(2):145. DOI: 10.3390/bioengineering10020145.
[18] Guedes M, Vernooij RWM, Davenport A, et al. Clinical performance, intermediate and long-term outcomes of high-volume hemodiafiltration in patients with kidney failure[J]. Semin Dial, 2022, 35(5):420-426. DOI: 10.1111/sdi.13105.
[19] 刘雄.血液灌流结合血液透析对终末期肾病患者钙磷代谢及心脏功能的影响[J].吉林医学,2022,43(2):370-372.DOI:10.3969/j.issn.1004-0412.2022.02.031.
[20] Yeung WG, Palmer SC, Strippoli GFM, et al. Vitamin D therapy in adults with CKD: a systematic review and meta-analysis[J]. Am J Kidney Dis, 2023, 82(5):543-558. DOI: 10.1053/j.ajkd.2023.04.003.
[21] An N, Zhou H, Li X, et al. Effect of low-calcium and standard-calcium dialysate on serum calcium, phosphorus and full-segment parathyroid hormone in patients on peritoneal dialysis: a retrospective observational study[J]. Int J Artif Organs, 2023, 46(10-11):539-546. DOI: 10.1177/03913988231206641.
[22] Abdelsalam M, Demerdash TM, Assem M, et al. Improvement of clinical outcomes in dialysis: no convincing superiority in dialysis efficacy using hemodiafiltration vs high-flux hemodialysis[J]. Ther Apher Dial, 2021, 25(4):483-489. DOI: 10.1111/1744- 9987.13492.
[23] 张帆,江杨,龚宇,等.血液透析滤过对终末期肾病患者钙磷代谢及心血管并发症的影响[J].中国实验诊断学,2023,27(1):17-20.DOI:10.3969/j.issn.1007-4287.2023.01.006.
[24] 王坚,谢瑜,陈丽娟.慢性肾脏病NF-κB p65和炎性因子与动脉硬化的关系及HDF治疗对其影响[J].中国老年学杂志,2024,44(3):581-583.DOI:10.3969/j.issn.1005-9202. 2024.03.018.
[25] Drüeke TB, Ikizler TA. Is hemodiafiltration superior to hemodialysis in patients with kidney failure?[J]. Kidney Int, 2023, 104(5):874-877. DOI: 10.1016/j.kint.2023. 07.012.
[26] Martínez-Arias L, Panizo-García S, Martín-Vírgala J, et al. Contribution of phosphorus and PTH to the development of cardiac hypertrophy and fibrosis in an experimental model of chronic renal failure[J]. Nefrologia (Engl Ed), 2021, 41(6):640-651. DOI: 10.1016/j.nefroe.2021.12.004.
[27] 杨彦平,李海燕,刘国.腹膜透析与高通量血液透析对老年终末期肾病患者氧化应激水平及细胞免疫功能的影响[J].中国现代医学杂志,2020,30(16):77-80.DOI:10.3969/j.issn.1005-8982.2020.16.015.
[28] Ebert T, Neytchev O, Witasp A, et al. Inflammation and oxidative stress in chronic kidney disease and dialysis patients[J]. Antioxid Redox Signal, 2021, 35(17):1426-1448. DOI: 10.1089/ars.2020.8184.
[29] Balali A, Nehls MS, Tabibi H, et al. Dietary acid load and markers of malnutrition, inflammation, and oxidative stress in hemodialysis patients[J]. Front Nutr, 2024, 11:1369206. DOI: 10.3389/fnut.2024.1369206.
[30] Ling L, Bi X, Yao L, et al. The correlation between serum growth differentiation factor 15 and malnutrition in patients with end-stage kidney disease on hemodialysis[J]. Ren Fail, 2023,45(2):2276911. DOI: 10.1080/0886022X.2023.2276911.