Hemodiafiltration Treatment Research Articles

Comparison of clinical effect of different dialysis frequency and methods in the treatment of chronic renal failure uremic patients

Objective To observe the clinical efficacy of different dialysis frequency and methods in the treatment of chronic renal failure uremia patients, and to provide a reliable reference for clinical practice. Methods From February 2016 to February 2017, 140 chronic renal failure uremic patients who admitted to the Department of Nephrology at Taizhou Central Hospital were selected and divided into the observation group and the control group by complete random distribution method, with 70 cases in each group.The patients in the control group received 3 times of regular hemodialysis treatment per week, while the observation group received 3 times of regular hemodialysis combined with 1 time of hemodiafiltration treatment per week.The clinical treatment effects and complications of the two groups were compared. Results Compared with blood uric acid(BUA)[(532.09±71.05)mmol/L], serum creatinine(Scr)[(734.34±63.08)μmol/L], blood urea(BUN)[(23.84±2.58)mmol/L], serum phosphorus[(1.98±0.37)mmol/L], parathyroid hormone(PTH)[(464.37±113.92)ng/L], β2 microglobulin(β2-MG)[(13.48±6.38)mg/L]in the control group, BUA[(495.89±58.23)mmol/L], Scr[(684.34±77.32)μmol/L], BUN[(20.62±1.77)mmol/L], serum phosphorus[(1.74±0.44)mmol/L], PTH[(352.14±123.25)ng/L], β2-MG[(9.58±5.45)mg/L] were significantly lower in the observation group, the differences were statistically significant (t=3.29, 4.19, 8.61, 3.49, 5.59, 3.88, all P 0.05). Conclusion Hemodialysis 3 times combined with 1 time of hemodiafiltration per week has significant advantage in the treatment of chronic renal failure uremia patients, which can effectively remove urine toxin molecules and reduce the incidence of complications, and it is worthy of clinical application. Key words: Renal failure, chronic; Uremia; Hemodialysis; Hemodiafiltration; Comparative effectiveness research

Via continuous hemodiafiltration treatment for severe diabetic ketoacidosis in 2 children

对2017年苏州大学附属儿童医院内分泌遗传代谢科和重症医学科收治的2例糖尿病酮症酸中毒危重患儿的临床表现、实验室检查及抢救治疗过程进行回顾性分析。例1，女，13岁5个月，诊断1型糖尿病、酮症酸中毒、急性肾损伤(3期)；例2，女，2个月8 d，诊断新生儿糖尿病、酮症酸中毒、高渗高血糖综合征，予常规补液、胰岛素降糖治疗效果不佳，行连续性血液透析滤过治疗后缓解；为明确病因，行基因检测，例2检出KCNJ11基因存在c.602G>A(p.R201H)杂合突变。提示对于儿童糖尿病酮症酸中毒危重患者，在常规补液、胰岛素降糖治疗效果不佳，合并其他器官功能损伤及顽固性酸中毒时，积极行连续性血液透析滤过治疗，可获得显著效果。

MON-114 COMPARISON OF ON-LINE HEMODIAFILTRATION AND HEMODIALYSIS ON THE REMOVAL RATE OF DRUGS

Recent data suggest that the removal rate of drugs is higher in predilution on-line hemodiafiltration(HDF) treatment because of the result in temporary reduction of serum protein binding rate. However, as far as searching, there are few studies comparing drug removal rates for Online-HDF and conventional hemodialysis therapy (HD). In this study, we compared the removal rate of drugs between in predilution on-line HDF and HD treatment.

Pharmacokinetics and pharmacodynamics ofcinacalcet in patients with renal failure receiving hemodialysis and hemodiafiltrationtherapy .

Few studies have focused on the effects of dialysis on cinacalcet. In addition, there is no data available on hemodiafiltration (HDF) all over the world. Therefore, we studied the pharmacokinetics (PK) and pharmacodynamics (PD) of cinacalcet in patients undergoing hemodialysis (HD) or HDF to provide more guiding information on its use in these patients, especially in China. In this open-label, single-dose, single-center study of 7 patients with renal failure who underwent dialysis, patients were randomly allocated to two groups consisting of 4 and 3 patients who received low-flux HD and HDF treatments, respectively. All participants underwent dialysis for 4 hours immediately after receiving single oral doses of a 25mg cinacalcet tablet. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and electrochemical luminescence (EI) were used to determine the cinacalcet plasma concentrations and intact parathyroid hormone (iPTH) serum levels, respectively. Peak concentration (Cmax) and area under the curve (AUC) from time 0 to 24 hours (AUC0-24h) of the low-flux HD therapy group were 21.8±18.6 ng/mL and 145.3±91.8 ng×h/mL, respectively, which were similar to those of the HDF group (30.9±7.9 ng/mL and 161.6±26.5 ng×h/mL, respectively). iPTH concentrations of the HD therapy group decreased after cinacalcet administration and increased following its clearance. However, iPTH levels of subjects receiving HDF therapy did not change. Compared with healthy Chinese subjects, patients with renal failure had a higher Cmax and AUC0-24h, slightly prolonged time to Cmax (tmax) after administration of the same dose of cinacalcet. On HD treatment day, variation trends of iPTH in Chinese patients and healthy subjects were similar and significantly different from that on the HDF treatment day. Considering the high protein binding rate of cinacalcet, this may lead to the great free-drug clearance during HDF treatment.

Biocompatibility of Hemodialysis.

This study was designed to investigate the biocompatibility of hemodialysis procedures, largely depending on the contact of patient's blood with the dialysis membranes. We addressed the issue by comparing the content of the proteolytic enzymes collagenase and cathepsin B and that of neutrophil myeloperoxidase (MPO) and C-reactive protein (CRP) in the blood before and after a single session treatment and a full course of successive 8-week-long therapies with three types of hemodialysis: low-flux (lfHD), high-flux (hfHD), and post-dilution hemodiafiltration (HDF). The study included 19 patients with chronic nephropathy. We found that collagenase significantly increased after a single session of each type of hemodialysis. Cathepsin B tended to decrease after single sessions; the decrease reached significance only after hfHD. CRP increased significantly after single hfHD and HDF treatments. These changes were meager, with no differences depending on the dialysis type, and their significance was lost after 8-week-long therapy, except the persisting increase in CRP after HDF. Neutrophil MPO apparently was not activated during any type of dialysis, as its content was below the detection threshold. We conclude that all three types of hemodialysis are compatible with the biological system, so that they would rather unlikely lead to clinically harmful effects in chronically hemodialyzed patients. Nonetheless, proteolytic enzymes and myeloperoxidase seem hardly appropriable estimators of hemodialysis biocompatibility due to meager and variable changes. Upregulation of C-reactive protein, on the other hand, expresses a general pro-inflammatory propensity of hemodialysis and is not a suitable estimator of biocompatibility either.

Efficacy of different hemodialysis methods on dendritic cell marker CD40 and CD80 and platelet activation marker CD62P and P10 in patients with chronic renal failure.

Chronic renal failure (CRF) has become a major public health concern, which increases the risk of stroke and systemic thromboembolism. Therefore, therapeutic strategies are in urgent requirement. This study was conducted for investigating efficacy of hemodialysis (HD), hemodiafiltration (HDF), and hemoperfusion (HP) in patients with CRF and the correlation with the presence of complications following HD therapy. The therapeutic effect, living quality, biochemical indicators, and dry weight were detected before and after the treatment regimens. Flow cytometry was conducted to detect expressions of dendritic cell markers (CD40 and CD80) and platelet activation markers (CD62P and P10), and the relationship between their expression and therapeutic effect as well as the association of these expressions with complications was analyzed. After HD therapy, patients presented with decreased serum creatinine, serum phosphorus, triglyceride, parathyroid hormone, and β2 -MG expression; increased hemoglobin, plasma albumin expressions, and dry weight; and enhanced therapeutic effect and living quality. CD62P and P10 expressions decreased, while CD40 and CD80 expressions increased following HD therapy. The therapeutic effect improved in patients with low expressions of CD40 and CD80 and high expressions of CD62P and P10 following HP treatment and complications were lower after treatment of HDF and HP. The aforementioned results indicated that CRF patients treated with HP exhibited higher expression of CD40 and CD80 and lower expression of CD62P and P10, suggesting that HP is conferred to have better efficacy than HDF and HD. Therefore, HP may be a promising clinical regimen for treatment of CRF patients.

Zero Diffusive Sodium Balance in Hemodialysis Provided by an Algorithm-Based Electrolyte Balancing Controller: A Proof of Principle Clinical Study.

Restoring and controlling fluid volume homeostasis is still a challenge in contemporary end-stage kidney disease patients treated by intermittent hemodialysis (HD) or hemodiafiltration (HDF). This primary target is achieved by ultrafiltration (dry weight probing) and control of intradialytic sodium transfer (dialysate-plasma Na gradient). The latter task is mostly ignored in clinical practice by applying a dialysate sodium prescription uniform for all patients of the dialysis center but unaligned to individual plasma sodium levels. Depending on the patient's natremia, a positive gradient gives rise to intradialytic diffusive sodium load and postdialytic thirst. On the contrary, a negative gradient may cause unwanted diffusive sodium removal and intradialytic symptoms. To overcome these challenges, a new conductivity-based electrolyte balancing algorithm embedded in a hemodialysis machine with the aim to achieve "zero diffusive sodium balance" in HD and online HDF treatments was tested in the form of a prospective clinical trial. The study comprised two phases: a first phase with a conventional fixed-sodium dialysate (standard care phase), followed by a phase with the electrolyte balancing control (EBC) module activated (controlled care phase). The results show a reduction in the variability of the intradialytic plasma sodium concentration shift, but it is overlain by a small but statistically significant increase in the mean plasma sodium levels. However, no clinical manifestations were observed. This sodium load can be explained by the design of the algorithm based on dialysate conductivity instead of sodium concentration. Furthermore, the increase in plasma sodium can be corrected by taking into account the potassium shift during the treatment. This study showed that the EBC module incorporated in the HD machine is able to automatically individualize the dialysate sodium to the patient's plasma sodium without measuring or calculating predialytic plasma levels from previous laboratory tests. This tool has the potential to facilitate fluid management, to control diffusive sodium flux, and to improve intradialytic tolerance in daily clinical practice.

A unidimensional diffusion model applied to uremic toxin kinetics in haemodiafiltration treatments.

Kinetic modelling in haemodialysis is usually based upon the resolution of volume-defined compartment models. The interaction among these compartments is described by purely diffusive processes. In this paper we present an alternative kinetic model for uremic toxins in post-dilutional haemodiafiltration treatments by means of a unidimensional diffusion equation. A wide range of solutes such as urea, creatinine, $\beta _{2}$-microglobulin, myoglobin and prolactin were studied by imposing appropriate boundary and initial conditions in a virtual [0,1] domain. The diffusivity along the domain and the extraction rate at the dialyser are the kinetic parameters which were fitted by least-squares for every studied solute. The accuracy of the presented volumeless model as well as the behavior of the proposed kinetic parameters could be an alternative to the compartment description for a variety of molecular weight uremic toxins undergoing different treatment configurations.

Functional impairment and risk of mortality in patients on chronic hemodialysis: results of the Lazio Dialysis Registry.

Functional impairment is associated with adverse outcomes in older people, as well as in patients on chronic hemodialysis. The aim of this study was to evaluate if functional impairment represents a risk factor for reduced survival in patients on chronic hemodialysis. All incident chronic hemodialysis patients of Lazio, a large region of central Italy, registered in the Dialysis and Transplant Lazio Region Registry (DTLRR) in the period 2008-2013 were considered eligible. Inclusion criteria were: age > 18 years, resident in Lazio, still doing dialysis after 90days from incidence date, doing hemodialysis or hemodiafiltration treatment for > 9h/week. Patients were stratified into three classes of functional activity: total autonomy, autonomy in some activities, and not self-sufficient. Functional activity was assessed for each patient by the referring physician for the DTLRR from the ~ 90 hemodialysis units of the Lazio region. Each patient was followed from date of first dialysis treatment to the end of the study (31/12/2015) or death or renal transplant, whichever occurred first. Cox proportional hazard models were performed to obtain mortality hazard ratios (HR), 95% confidence intervals (CI), for each class of functional activity adjusting for sex, age, country of birth, city of residence, body mass index (BMI), type of nephropathy, vascular access, previous nephrology counselling, weekly hours of hemodialysis, serum albumin, hemoglobin, and presence of comorbidities (e.g. vascular diseases, coronary disease, and diabetes). A total of 3356 patients were studied. In the whole follow-up period, 1622 deaths occurred (48%). Functional impairment was associated with the risk of mortality: compared to 'total autonomy', the HR for 'autonomy in some activities' was 1.30 [95% CI: 1.14-1.49] and for 'not self-sufficient' 1.71 [1.47-1.99] (p for trend < 0.05). The number of evitable deaths attributable to reduced functional activity was 237. Functional impairment represents a risk factor for reduced survival in chronic hemodialysis patients. There is a need for early identification of patients who might benefit from interventions aimed at preventing, reversing or delaying the functional impairment.

ST2 as a novel prognostic marker in end-stage renal disease patients on hemodiafiltration

BackgroundPatients with end-stage renal disease (ESRD) are prone to severe heart failure (HF) and to several life-threatening events. Therefore, the ability to assess disease prognosis and the risk of short-term events or death is of great importance. The role of soluble ST2 (sST2) as a potential new prognostic marker in ESRD patients is not yet known. The aim of our study was to assess the prognostic value of sST2 in ESRD patients on hemodiafiltration (HDF) and compare it with NT-proBNP, an established prognostic marker for HF and renal disease. Methods123 ESRD patients on HDF were prospectively followed up from the date of the sST2/NT-proBNP measurement until their death or maximally up to 829days. Patients were divided into a low sST2 group (<35ng/mL) or a high sST2 group (≥35ng/mL) according to their measured sST2 concentration at the start of the study. Kaplan-Meier survival curves, Cox regression model and ROC analyses were used in statistical analysis. ResultsDuring follow-up 32 (26.0%) patients died (all cause mortality). Median (IQR) sST2 serum concentrations of survivors and deceased were 26 (24–29) and 36 (28–59) ng/mL, respectively. The Kaplan-Meier survival analysis showed that survival rate of the high sST2 group was statistically significant lower than of the low sST2 group (P<0.01). Cox regression model for sST2, using a dichotomized (cut-off=35ng/mL, hazard ratio (HR) (95%CI)=2.72 (1.50–4.90), P=0.001) and continuous approach with log-transformed values in univariate (HR (95%CI)=17.35 (4.84–62.22), P<0.001) and multivariate analysis (HR (95%CI)=7.19 (1.89–27.38), P=0.004) showed that sST2 alone and in combination with NT-proBNP can predict all cause mortality. ConclusionssST2 has confirmed prognostic value and is independent of renal function and of HDF treatment. It could be useful independent prognostic marker for stratifying ESRD patients on HDF at high risk for life-threatening events, hospitalisation and death, especially in combination with NT-proBNP.

Research of hemodialysis combined with hemodiafiltration in removing hepcidin in maintenance hemodialysis patients

Objective To compare the changes of serum hepcidin, hemoglobin and other indexes of pure hemodialysis and hemodialysis combined with hemodiafiltration in treatment of maintenance hemodialysis patients, and to investigate the effect of hemodialysis combined with hemodiafiltration therapy on serum hepcidin clearance, the improvement of anemia and the relationship between them of maintenance hemodialysis patients. Methods Twenty-two patients with maintenance hemodialysis patients were collected from Shengjing Hosphal Affiliated to China Medical University from January 2015 to February 2017.This study was self-controlled study, before enrollment all patients were given only regular hemodialysis, after enrollment all patients were given hemodialysis combined with hemodiafiltration therapy for 3 months, compared the changes of serum hepcidin, hemoglobin, reticulocyte percentage, ferritin, serum iron, transferrin saturation and EPO of pure hemodialysis(before treatment) and hemodialysis combined with hemodiafiltration treatment for 3 months of patients, and analyzed the correlationship between serum hepcidin and other indexes. Results After hemodialysis combined with hemodiafiltration therapy for 3 months, compared with pure hemodialysis serum hepcidin levels were significantly lower((77.61±3.31) μg/L vs.(89.49±7.87) μg/L, t=9.660, P<0.01), hemoglobin levels were increased((112.73±11.02) g/L vs.(88.32±11.83) g/L, t=-11.957, P<0.01). The correlations between serum hepcidin and other indexes show that serum hepcidin and hemoglobin and ferritin were related, serum hepcidin was negatively correlated with hemoglobin(r=-0.851, P<0.01)and positively correlated with ferritin(r=0.385, P<0.05), and found no correlations between hepcidin and reticulocyte percentage(r=-0.151, P=0.328), serum iron(r=0.123, P=0.427), transferrin saturation(r=0.211, P=0.170) and EPO(r=-0.173, P=0.261). Conclusion To compare with pure hemodialysis, hemodialysis combined with hemodiafiltration therapy can more effectively remove hepcidin and improve anemia, and they are related. Key words: Hepcidin; Hemodialysis; Hemodiafiltration; Iron metabolism; Anemia

PHARMACO-ECONOMICBENEFITS OF CORRECTION OF ANEMIA WITH CONTINUOUS ERYTHROPOIETIN RECEPTOR ACTIVATOR:HEMODIALYSIS VSHEMODIAFILTRATION

Anemia is an integral component of CKD. The prescribing of erythropoiesis stimulating agents (ESA) for the treatment of anemia constitutes a significant burden on health budgets. Using of continuous erythropoietin receptor activator (CERA) and convective techniques can improve health indicators and economic results.&#x0D; The aim of the study was to evaluate the effects of hemodiafiltration treatment (HDF) on the pharmaco-economic efficiency of anemia treatment in comparison with haemodialysis (HD).&#x0D; Methods. A prospective cross-sectional study involving 40 patients with CKD stage V who receiving dialysis treatment at the LLC “Fresenius Medical Care Ukraine ” Medical center in Cherkasy city. The follow-up period was 2 years. First, data was analyzed while patients received HD over a period of twelve months. Then, the same patients were evaluated during treatment with HDF for at least another twelve months.&#x0D; &#x0D; Result. The average dose of CERA reduced from 60 mg to 44 mg per month (p = 0.002) after the transferred ofpatients to HDF treatment. There were a significantly increased the levels of Kt / V (p = 0.04) and serum albumin (p = 0.04). A higher number of patients achieved the target hemoglobin results.&#x0D; Conclusions. The comparison of pharmaco-economic component of anemia correction with CERA cross-sectional study demonstrates significant advantages of HDF treatment compared to HD.&#x0D;

The importance of considering competing treatment affecting prognosis in the evaluation of therapy in trials: the example of renal transplantation in hemodialysis trials.

During the follow-up in a randomized controlled trial (RCT), participants may receive additional (non-randomly allocated) treatment that affects the outcome. Typically such additional treatment is not taken into account in evaluation of the results. Two pivotal trials of the effects of hemodiafiltration (HDF) versus hemodialysis (HD) on mortality in patients with end-stage renal disease reported differing results. We set out to evaluate to what extent methods to take other treatments (i.e. renal transplantation) into account may explain the difference in findings between RCTs. This is illustrated using a clinical example of two RCTs estimating the effect of HDF versus HD on mortality. Using individual patient data from the Estudio de Supervivencia de Hemodiafiltración On-Line (ESHOL; n = 902) and The Dutch CONvective TRAnsport STudy (CONTRAST; n = 714) trials, five methods for estimating the effect of HDF versus HD on all-cause mortality were compared: intention-to-treat (ITT) analysis (i.e. not taking renal transplantation into account), per protocol exclusion (PP excl ; exclusion of patients who receive transplantation), PP cens (censoring patients at the time of transplantation), transplantation-adjusted (TA) analysis and an extension of the TA analysis (TA ext ) with additional adjustment for variables related to both the risk of receiving a transplant and the risk of an outcome (transplantation-outcome confounders). Cox proportional hazards models were applied. Unadjusted ITT analysis of all-cause mortality led to differing results between CONTRAST and ESHOL: hazard ratio (HR) 0.95 (95% CI 0.75-1.20) and HR 0.76 (95% CI 0.59-0.97), respectively; difference between 5 and 24% risk reductions. Similar differences between the two trials were observed for the other unadjusted analytical methods (PP cens, PP excl , TA) The HRs of HDF versus HD treatment became more similar after adding transplantation as a time-varying covariate and including transplantation-outcome confounders: HR 0.89 (95% CI 0.69-1.13) in CONTRAST and HR 0.80 (95% CI 0.62-1.02) in ESHOL. The apparent differences in estimated treatment effects between two dialysis trials were to a large extent attributable to differences in applied methodology for taking renal transplantation into account in their final analyses. Our results exemplify the necessity of careful consideration of the treatment effect of interest when estimating the therapeutic effect in RCTs in which participants may receive additional treatments.

Modulation of Myostatin/Hepatocyte Growth Factor Balance by Different Hemodialysis Modalities.

Background. In this study we investigated the relevance of myostatin and Hepatocyte Growth Factor (HGF) in patients undergoing hemodialysis HD and the influence of different HD modalities on their levels. Methods. We performed a prospective crossover study in which HD patients were randomized to undergo 3-month treatment periods with bicarbonate hemodialysis (BHD) followed by online hemodiafiltration (HDF). Clinical data, laboratory parameters, and myostatin and HGF serum levels were collected and compared. Results. Ten patients and six controls (C) were evaluated. In any experimental condition myostatin and HGF levels were higher in HD than in C. At enrollment and after BHD there were not significant correlations, whereas at the end of the HDF treatment period myostatin and HGF were inversely correlated (r −0.65, p < 0.05), myostatin serum levels inversely correlated with transferrin (r −0.73, p < 0.05), and HGF levels that resulted positively correlated with BMI (r 0.67, p < 0.05). Moving from BHD to HDF, clinical and laboratory parameters were unchanged, as well as serum HGF, whereas myostatin levels significantly decreased (6.3 ± 4.1 versus 4.3 ± 3.1 ng/ml, p < 0.05). Conclusions. Modulation of myostatin levels and myostatin/HGF balance by the use of different HD modalities might represent a novel approach to the prevention and treatment of HD-related muscle wasting syndrome.

A Randomized, Single-Blind, Crossover Trial of Recovery Time in High-Flux Hemodialysis and Hemodiafiltration

BackgroundThe choice between hemodiafiltration (HDF) or high-flux hemodialysis (HD) to treat end-stage kidney disease remains a matter of debate. The duration of recovery time after treatment has been associated with mortality, affects quality of life, and may therefore be important in informing patient choice. We aimed to establish whether recovery time is influenced by treatment with HDF or HD.Study DesignRandomized patient-blinded crossover trial.Settings & Participants100 patients with end-stage kidney disease were enrolled from 2 satellite dialysis units in Glasgow, United Kingdom.Intervention8 weeks of HD followed by 8 weeks of online postdilution HDF or vice versa.OutcomesPosttreatment recovery time, symptomatic hypotension events, dialysis circuit clotting events, and biochemical parameters.MeasurementsPatient-reported recovery time in minutes, incidence of adverse events during treatments, hematology and biochemistry results, quality-of-life questionnaire.ResultsThere was no overall difference in recovery time between treatments (medians for HDF vs HD of 47.5 [IQR, 0-240] vs 30 [IQR, 0-210] minutes, respectively; P = 0.9). During HDF treatment, there were significant increases in rates of symptomatic hypotension (8.0% in HDF vs 5.3% in HD; relative risk [RR], 1.52; 95% CI, 1.2-1.9; P < 0.001) and intradialytic tendency to clotting (1.8% in HDF vs 0.7% in HD; RR, 2.7; 95% CI, 1.5-5.0; P = 0.002). Serum albumin level was significantly lower during HDF (3.2 vs 3.3 g/dL; P < 0.001). Health-related quality-of-life scores were equivalent.LimitationsSingle center; mean achieved HDF convection volume, 20.6 L.ConclusionsPatients blinded to whether they were receiving HD or HDF in a randomized controlled crossover study reported similar posttreatment recovery times and health-related quality-of-life scores.

Fundamental Characteristics of the Newly Developed ATA™ Membrane Dialyzer.

Dialysis membranes are often made from synthetic polymers, such as polysulfone. However, membranes made from cellulose triacetate have superior biocompatibility and have been used since the 1980s. On-line hemodiafiltration treatment accompanied by massive fluid replacement is increasingly being used in Europe and Japan, but cellulose triacetate is not suitable for this treatment. Our newly developed asymmetric triacetate membrane, the ATA™ membrane, substantially improved the filtration properties and blood compatibility because of the asymmetric structure and smooth surface of this cellulose acetate membrane. Key Message: The ATA membrane maintains its high permeability even after massive filtration and shows less temporal variation in its permeation performance, lower protein adsorption, and superior biocompatibility compared with conventional membranes.

Valoración de la calidad de vida relacionada con la salud en la enfermedad renal crónica terminal mediante un cuestionario de resultados percibidos por los pacientes

Objetivos: Valorar la Calidad de Vida Relacionada con la Salud de los pacientes con Enfermedad Renal Crónica Terminal e identificar las diferencias más significativas según el sexo y tratamiento recibido. Material y métodos: Estudio observacional, analítico y transversal; realizado a pacientes en tratamiento con Hemodiálisis de Alto Flujo o Hemodiafiltración "en línea". Realizamos estadística descriptiva e inferencial y se consideraron significativos aquellos resultados en que el grado de significación resultó igual o inferior al 5% (p=0.05). Resultados: Obtuvimos diferencias estadísticamente significativas en: valores de albúmina sérica según la técnica de diálisis y dosis de tratamiento adecuado (Kt/V) según el sexo. En las dimensiones del test de calidad de vida: síntomas/problemas, situación laboral, función sexual, función física, dolor y vitalidad (según sexo). Y según la técnica en: sueño, actitud del personal de diálisis y función física. En el análisis multivariante, las únicas variables clínicas y sociodemográficas que resultaron ser predictores significativos en algunas de las dimensiones de las escalas KDQOL-SF fueron el sexo, el nivel de estudios y la técnica de diálisis. Conclusiones: Las variables sociodemográficas, analíticas, el sexo y técnicas de diálisis influyen sobre la percepción de la calidad de vida de los pacientes con enfermedad renal crónica terminal.

Using the cytokinesis-block micronucleus cytome assay to evaluate chromosomal DNA damage in chronic renal patients undergoing bicarbonate haemodialysis and haemodiafiltration.

Chronic Renal Failure (CRF) patients are considered to show genomic instability and are associated with a high risk of both cardiovascular diseases and cancer. We explored DNA damage due to two dialysis treatments in 20 patients undergoing bicarbonate haemodialysis (BD), 20 undergoing haemodiafiltration (HDF) and 40 healthy subjects. The cytokinesis-block micronucleus (MN) assay was performed on peripheral blood lymphocytes to evaluate genetic damage. A higher frequency of MN in the dialysis groups compared with controls was found. The results do not show a relationship between genetic instability and the type, frequency and duration of haemodialysis. The average BD and HDF treatment time was respectively 3.8 ± 6.3 and 3.7 ± 3.9 yrs. CAT and scintigraphy was independently correlated with high levels of MN. Overall, the frequency of MN in CRF patients undergoing dialysis therapy was observed to be higher. Further studies need to be performed on a larger number of patients and for a longer period.

Part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration in the treatment of severe acute liver failure.

The present study is a retrospective analysis of 11 cases with severe acute liver failure combined with multiple organ dysfunction syndrome (MODS) performed during the period June, 2012 to December, 2014. After part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration treatment, good curative effects were obtained and the main clinical symptoms and biochemical index were significantly improved. Following treatment, 8 of the 11 patients survived at a survival rate of 72.7%, and 3 patients succumbed with a mortality of 27.3%. The results suggested that part of plasmapheresis with plasma filtration adsorption combined with continuous venovenous hemodiafiltration (CVVHDF) treatment is beneficial in the removal of metabolites and toxins. Additonally, it can effectively improve liver function and clinical symptoms, improve hepatic encephalopathy, correct the disorder of internal environment, and improve the prognosis of patients.

Dynamics of the erythropoiesis stimulating agent resistance index in incident hemodiafiltration and high-flux hemodialysis patients

Hyporesponsiveness to erythropoiesis-stimulating agent therapy in dialysis patients is poorly understood. Some studies report an improvement in the erythropoiesis-stimulating agent resistance index (ERI) with hemodiafiltration (HDF) versus high-flux hemodialysis (HD). We explored ERI dynamics in 38,340 incident HDF and HD patients treated in 22 countries over a 7-year period. Groups were matched bypropensity score at baseline (6 months after dialysis initiation). The follow-up period (mean of 1.31 years) was stratified into 1 month intervals with delta analyses performed for key ERI-related parameters. Dialysis modality, time interval, and polycystic kidney disease were included in a linear mixed model with the outcome ERI. Baseline ERI was nonsignificantly higher in HDF versus HD treatment. ERI decreased significantly faster in HDF-treated patients than inHD-treated patients, was decreased in both HD and HDF when patients were treated with intravenous darbepoetin alfa, but only in HDF when treated with intravenous recombinant human erythropoietin (rHuEPO). A clear difference between HD- and HDF-treated patients could only be found for patients with high baseline ERI and assigned to intravenous rHuEPO treatment. A significant advantage in terms of lower ERI for patients treated by HDF was found. Sensitivity analysis limited this advantage for HDF to those patients treated with intravenous rHuEPO (not darbepoetin alfa or subcutaneous rHuEPO) and to patients with a high baseline ERI. Thus, our results allow more accurate planning for future clinical trials addressing anemia management in dialysis patients.