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

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