High-flux Hemodialysis Group Research Articles

The CONVINCE randomized trial found positive effects on quality of life for patients with chronic kidney disease treated with hemodiafiltration

In the CONVINCE trial, the primary analysis demonstrated a survival benefit for patients receiving high-dose hemodiafiltration (HDF) as compared with high-flux hemodialysis (HD). A secondary objective was to evaluate effects on health-related quality of life (HRQoL); assessed in eight domains (physical function, cognitive function, fatigue, sleep disturbance, anxiety, depression, pain interference, social participation) applying instruments from the Patient-Reported Outcome Measurement Information System (PROMIS) before randomization and every three months thereafter. In total 1360 adults with dialysis-dependent chronic kidney disease, eligible to receive high-flux HDF (23 liters or more), were randomized (1:1); 84% response rate to all questionnaires. Both groups reported a continuous deterioration in all HRQoL domains. Overall, raw score changes from baseline were more favorable in the HDF group, resulting in a significant omnibus test after a median observation period of 30 months. Most relevant single raw score differences were reported for cognitive function. Patients receiving HDF reported a decline of -0.95 units (95% confidence interval - 2.23 to +0.34) whereas HD treated patients declined by -3.90 units (-5.28 to - 2.52). A joint model, adjusted for mortality differences, utilizing all quarterly assessments, identified a significantly slower HRQoL decline in physical function, cognitive function, pain interference, and social participation for the HDF group. Their physical health summary score declined -0.46 units/year slower compared to the HD group. Thus, the CONVINCE trial showed a beneficial effect of high-dose hemodiafiltration for survival as well as a moderate positive effect on patients’ quality of life, most pronounced with respect to their cognitive function.

High-flux Hemodialysis Does Not Increase Vitamin B Loss Compared With Low-flux Hemodialysis

A consistent effect of hemodialysis (HD) on vitamin B loss has not been fully demonstrated and the effect of high-flux hemodialysis (HFHD) is also inconclusive. The aim of this study was to identify the loss of vitamin B1, B3, B5, and B6 in a single HD session and to evaluate the effect of HFHD on vitamin B removal. Patients on maintenance HD were enrolled in this study. They were divided into low-flux hemodialysis (LFHD) group and HFHD group. Vitamin B1, B3, B5, and B6 (pyridoxal 5'-phosphate [PLP]) concentrations in blood pre- and post-HD sessions, as well as in the spent dialysate were measured. Loss of vitamin B was calculated and the difference in vitamin B loss between the 2 groups was compared. The association between HFHD and vitamin B loss was estimated using multivariable linear regression analysis. Seventy-six patients were included, of whom 29 were on LFHD and 47 were on HFHD. The median reduction ratio of serum vitamins B1, B3, B5, and B6 after a single HD session was 38.1%, 24.9%, 48.4%, and 44.7%, respectively. The median concentration of vitamins B1, B3, B5, and B6 in the dialysate was 0.3μg/L, 2.9μg/mL, 2.0μg/L, and 0.4ng/mL. There was no difference in either the reduction ratio of vitamin B in blood, or the concentration in dialysate between LFHD and HFHD groups. After adjusting for covariates by multivariable regression, HFHD had no effect on vitamin B1, B3, B5, or B6 removal. Vitamins B1, B3, B5, and B6 can be removed by HD and HFHD does not increase the loss.

Evaluation of the impact of high-volume online hemodiafiltration on glycemic status, hydration status, and body fat content in diabetic patients

Abstract Background: The increasing patients with diabetes undergoing hemodialysis (HD) have concerned about the issue of glucose delivery with substitution fluid. We evaluate the effects of online high-volume hemodiafiltration (OL-HDF) versus high flux HD (HF-HD) on the influence of glycemic status and body fat content in patients with type 2 diabetes mellitus (T2DM) receiving HD. Objectives: The influence glucose in substitution fluid on glycemic status and body fat content in patients with type 2 diabetes mellitus. Methods: This study evaluated 117 patients receiving HD for more than 3 months (17 patients with T2DM receiving high-volume OL-HDF and the other 100 patients receiving HF-HD). Initially, we performed a cross-sectional study and later examined two modalities of high-volume OL-HDF in a 9-month cross-over study. Overall glycemic control was estimated from the fasting blood glucose (FBG) and the hemoglobin A1c (HbA1c) levels. Body composition and nutritional status were assessed by bioimpedance spectroscopy. Results: FBG and HbA1c were not significantly different in both groups of patients after having followed for 12 weeks. No significant differences were found in overhydration status and body fat content between the two therapy modalities. The blood hemoglobin (Hb) level increased in the high-volume OL-HDF group compared with the HF-HD group. Additionally, no differences were observed in glycemic status, body mass index, or body fat mass between both high-volume pre- and post-dilutional OL-HDF. Conclusion: High-volume OL-HDF did not have an adverse impact on glycemic status, body mass index, and body fat content in patients with diabetes undergoing HD in our short-term study. A large-scale and long-term follow-up study is required to confirm these results.

Randomized Control Study on Hemoperfusion Combined with Hemodialysis versus Standard Hemodialysis: Effects on Middle-Molecular-Weight Toxins and Uremic Pruritus

Introduction: Classic hemodialysis schedules present inadequate middle-molecular-weight toxin clearance due to limitations of membrane-based separation processes. Accumulation of uremic retention solutes may result in specific symptoms (e.g., pruritus) and may affect clinical outcome and patient’s quality of life. Hemoperfusion (HP) is a blood purification modality based on adsorption that can overcome such limitations, and thus, it may be interesting to test the efficacy of at least one session per week of HP combined with hemodialysis. This is a randomized, open-label trial, controlled, multicenter clinical study to investigate the effect of long-term HP combined with hemodialysis on middle-molecular-weight toxins and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods: 438 MHD patients from 37 HD centers in China with end-stage kidney disease (63.9% males, mean age 51 years) suffering from chronic intractable pruritus were enrolled in the study. Eligible patients were randomized into four groups: low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), HP + LFHD, and HP + HFHD at a 1:1:1:1 ratio. Beta-2 microglobulin (β2M) and parathyroid hormone (PTH) were measured at baseline, 3–6, and 12 months. At the same time points, the pruritus score was evaluated. The primary outcome was the reduction of β2M and PTH, while the secondary outcome was the reduction of the pruritus score. Results: In the two groups HP + LFHD and HP + HFHD, there was a significant decrease of β2M and PTH levels after 12 months compared to the control groups. No significant differences were noted between HP + LFHD and HP + HFHD. Pruritus score reduction was 63% in the HP + LFHD group and 51% in the HP + HFHD group, respectively. Conclusion: The long-term HP + HD can reduce β2M and PTH levels and improve pruritus in MHD patients independently on the use of high- or low-flux dialyzers, showing that the results are linked to the effect of adsorption.

Mortality in High-Flux Hemodialysis vs. High-Volume Hemodiafiltration in Colombian Clinical Practice: A Propensity Score Matching Study

Background: The aim was to compare the effects of high-flux hemodialysis (HF-HD) versus high-volume post-dilution hemodiafiltration (HV-HDF) on mortality risk. Methods: Retrospective observational study of prevalent patients on hemodialysis who were followed for two years and treated in 28 kidney centers in Colombia. In this study, we included all adult patients who had been on dialysis for at least 90 days treated with an arteriovenous fistula. They were classified as HF-HD if they underwent this treatment exclusively (100% of time). For HV-HDF, if they received this treatment in more than 90% of the observation period. The primary outcome variable was mortality, and the type of hemodialysis therapy was considered as the exposure variable. Propensity score matching (PSM) and Cox regression models were used to evaluate the effect of dialysis modality on the mortality risk. Results: A total of 2933 patients were analyzed, 2361 patients with HF-HD and 572 with HV-HDF. After PSM, 1010 prevalent patients remained; mortality rate was 14.2% (95% Confidence Interval—CI: 11.3–17.6%) and 5.9% (95%CI: 4.0–8.4%) in HF-HD and HV-HDF group, respectively. HV-HDF therapy was associated with a 55% reduction in mortality compared with the HF-HD group (Hazards ratio-HR: 0.45 [95%CI 0.32–0.64] p < 0.001). Cardiovascular mortality rate was not statistically different between groups (HF-HD: 7.1% (36), HV-HDF: 3.4% (17), HR: 0.51 (95%CI: 0.21–1.28), p: 0.152). However, in patients younger than 60 years, a beneficial effect was observed in favor to HV-HDF therapy with a 79% reduction in cardiovascular mortality risk (HR: 0.21, (95%CI: 0.05–0.79), p: 0.021). Conclusion: After adjustment for different confounders, this study suggests that HV-HDF could reduce all-cause mortality compared to HF-HD therapy in prevalent patients on hemodialysis.

Economic evaluation of expanded hemodialysis with the Theranova 400 dialyzer: A post hoc evaluation of a randomized clinical trial in the United States.

IntroductionThe Theranova 400 is a medium cut‐off dialyzer that allows for superior clearance of larger middle molecules than traditional high‐flux dialyzers. This study evaluates the association of expanded hemodialysis (HDx) using the Theranova dialyzer versus conventional hemodialysis (HD) with a high‐flux dialyzer on hospitalization rates and healthcare costs as compared to conventional HD in a post hoc analysis of a randomized controlled trial.MethodsIn a non‐concealed, 24‐week clinical trial, maintenance HD patients were randomized to receive treatment with either Theranova 400 or a similar size high‐flux dialyzer. Hospitalization rate and average length of stay were calculated from trial data. Use of erythropoiesis‐stimulating agents and iron were assumed to be equal and therefore excluded from the model. Average cost per inpatient day was obtained from a publicly available published source. Probabilistic sensitivity analyses were conducted to account for variability in model inputs.FindingsThere were 86 patients (389 patient‐months) in the Theranova group and 85 patients (366 patient‐months) in the high‐flux HD group. All‐cause hospitalization rate was 45% lower with Theranova compared to high‐flux HD (IRR = 0.55; p = 0.05). Average annual estimated cost of hospitalization was $6098 lower with Theranova compared to high‐flux HD. Compared to high‐flux HD, average annual estimated cost associated with Theranova use was $4772 lower per patient. Hospitalization rate and hospital length of stay were the main drivers of cost.ConclusionsUse of the Theranova dialyzer is associated with lower estimated costs of care among maintenance HD patients, driven by fewer hospitalization events.

Effect of changing treatment to high-flux hemodialysis (HFHD) on mortality in patients with long-term low flux hemodialysis (LFHD): a propensity score matched cohort study

BackgroundThe purpose of this study was to explore the effect of changing treatment to high-flux hemodialysis (HFHD) on mortality rate in patients with long-term low flux hemodialysis (LFHD).MethodsThe patients with end-stage renal disease (ESRD) who underwent LFHD with dialysis age more than 36 months and stable condition in our hospital before December 31, 2014 were included in this study. They were divided into control group and observation group. Propensity score matched method was used to select patients in the control group. The hemodialysis was performed 3 times a week for 4 h. The deadline for follow-up is December 31, 2018. End-point event is all-cause death. The survival rates of the two groups were compared and multivariate Cox regression analysis was carried out.ResultsK-M survival analysis showed that the 1-year, 2-year, 3-year and 4-year survival rates of HFHD group were 98, 96, 96 and 96%, respectively. The 1-year, 2-year, 3-year and 4-year survival rates of LFHD group were 95, 85, 80 and 78%, respectively. Log-rank test showed that the survival rate of HFHD group was significantly higher than that of LFHD group (x2= 7.278, P = 0.007). Multivariate Cox regression analysis showed that male, age, hemoglobin and low-throughput dialysis were independent predictors of death (P < 0.05). Compared with LFHD, HFHD can significantly reduce the mortality risk ratio of patients, as high as 86%.ConclusionThe prognosis of patients with ESRD who performed long-term LFHD can be significantly improved after changing to HFHD.

The protective effect of different dialysis types on residual renal function in patients with maintenance hemodialysis: A systematic review and meta-analysis.

Residual renal function (RRF) is an important determinant of mortality and morbidity in patients undergoing hemodialysis. Different dialysis types may have different effects on RRF. We therefore conducted this meta-analysis to examine the RRF protective effect of different dialysis types for hemodialysis patients. A systematic search was performed on PubMed, EMbase, Web of Science, Chinese Biomedical Literature Database, Wanfang database, and China National Knowledge Infrastructure for randomized controlled trials and cohort studies. Dialysis types included low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), hemodiafiltration (HDF), and hemodialysis and hemoperfusion (HD+HP). The mean of endogenous creatinine clearance rate (CCR) and urea clearance rate (Curea), or urine volume was used to estimate RRF [95% confidence interval (95% CI), 6.05-16.80]. There were 12 articles involving 1224 patients, including 11 random controlled trials and 1 cohort study. Meta-analysis showed that the RRF protective effect of HFHD [mean difference (MD) = 1.48, 95% CI (2.11 to 0.86), P < .01] and HD+HP [MD = 0.41, 95% CI (0.69 to 0.12), P = .005] was better than that of LFHD, and the RRF decline rate was the lowest in HFHD group [MD = 0.13, 95% CI (0.17 to 0.09), P < .01]. Descriptive analysis showed that HDF could better protect RRF when compared with LFHD. However, there was no consistency among other interventions when removing LFHD due to limited data. For patients undergoing maintenance hemodialysis, the HFHD, HD+HP and HDF may better protect RRF, compared with LFHD.

Comparison of the efficacy of hemodialysis, hemodiafiltration and high-flux hemodialysis in the treatment of end-stage renal disease

Objective To observe the clinical efficacy of hemodialysis, hemodiafiltration and high-flux hemodialysis in the treatment of end-stage renal disease (ESRD). Methods A total of 205 patients with ESRD were divided into the hemodialysis (HD) group (n=110), high-flux hemodialysis (HFHD) group (n=30) and hemodiafiltration (HDF) group (n=65). Changes of nutrition indexes, inflammation factors, toxin molecules and electrolyte in blood before and after dialysis were observed and compared among the three groups, and the incidence of complications was recorded. Results After dialysis, PA and Hb were significantly increased in three groups (P<0.05), and the increase of Hb was more significant in HFHD group and HDF group than CHD group (P<0.05). After dialysis, UA, Cr and BUN changed significantly (P<0.05), but there were no significant differences between groups (P<0.05). β2-MG and Cysc were significantly decreased in HFHD group and HDF group (P<0.05). The two indexes were significantly lower in HFHD group and HDF group than HD group, and significantly lower in HDF group than HFHD group (P<0.05). After dialysis, Ca2+ in blood of the three groups were significantly increased (P<0.05), while K+ and P+ was significantly decreased (P<0.05), and there were significant differences among the three groups (P<0.05). After dialysis, levels of serum CRP, IL-6 and PTH in HFHD group and HDF group were significantly lower than those before dialysis and those in HD group (P<0.05), and the improvement of CRP, IL-6 and PTH was more significant in HDF group (P<0.05). There were significant differences among the three groups (P<0.05). Conclusions The medium and large molecule clearance rates in patients with ESRD and undergoing HDF and HFHD are significantly high than those in patients undergoing HD. The middle molecular substance removal by HDF is better than that of HFHD. Key words: Kidney Failure, Chronic; Renal Dialysis; Hemodiafiltration

Comparison of the effects of different blood purification methods on removal of macromolecules in uremia

Objective To compare the effects of different blood purification methods on the removal of large and medium molecular toxins in patients with maintenance hemodialysis(MHD), and to provide the clinical basis for selecting suitable dialysis modalities to prevent or delay the long term complications of uremic patients. Methods 60 MHD patients with long term and stable hemodialysis were enrolled in this study. All of them were selected from the patients with insufficient hemodialysis.According to the digital table, 60 patients were randomly divided into high flux hemodialysis (HFHD)group and hemodiafiltration (HDF) group, 30 cases in each group. And before, 3 months and 6 months after dialysis, the serum β2-MG, PTH and Cys C after dialysis were tested. Results The clearance of PTH in the HFHD group[(286.34±127.33)pg/mL] was significantly higher than that in the HDF group[(376.04±141.74)pg/mL], the difference was statistically significant(t=2.45, P<0.05). The clearance of β2 -MG in the HDF group[(11.34±1.96)mg/L]was significantly higher than that in the HFHD group[(15.41±3.02)mg/L], the difference was significant(t=5.88, P<0.05). The clearance of Cys C in the HFHD group[(263.67±98.72)μg/dL]was significantly higher than that in the HDF group[(345.63±105.00)μg/dL], the difference was statistically significant(t=2.96, P<0.05). Conclusion Both two dialysis methods are very effective in the removal of large and medium molecular uremic toxins in patients. In the removal of patients with increased PTH, HFHD is more effective. In the removal of patients with increased β2-MG, HDF is more effective. In the removal of Cys C, HFHD is better. Key words: Hemodiafiltration; Uremia

Effects of High Flux versus Low Flux on Serum C-Reactive Protein a as an Inflammatory Biomarker in Hemodialysis Patients

Background: Traditional low-flux dialysis cannot improve micro-inflammatory status, while new high-flux dialysis can improve the micro-inflammation and lipid metabolism, it helps to improve the quality of life and survival rate of patients, so how to improve the micro-inflammatory status are a focus for researchers. Objective: was to observe the effect of high flux hemodialysis (HFHD) with Gambro polyflux 170H dialyser and low flux hemodialysis (LFPD) with polyflux 17L dialyser on high-sensitivity C-reactive protein in patients with maintenance hemodialysis. Methods: 60 patients with maintenance hemodialysis were randomly divided into HFHD group and LFHD group. Another 20 cases for physical examinations served as normal control group. The maintenance hemodialysis patients were treated with HFHD using 170H dialyser dliahyser and LFHD using 17L dialyser, three times per week, 4 hours once. After 6 months of the treatment, high-sensitive C-reactive protein was determined in patients as well as normal controls before and after treatment. Results and Conclusion: in two groups, the levels of high-sensitive C-reactive protein before the treatment were higher than normal control (P <0.001). In HFHD group, serum high-sensitive C-reactive protein markedly decreased (P <0.01). In LFHD group, these indices remained unchanged after the dialysis for 6 months. HFHD with 170H polysulfone dialyser is effective in improving micro-inflammation in maintained hemodialysis patients.

The effect of high-flux hemodialysis on the inflammatory factors and serum brain natriuretic in hemodialysis patients with uremia

Objective To investigate the influence of the high-flux hemodialysis (HFD) on inflammatory factors[C-reactive protein (CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)]and serum brain natriuretic (BNP) in patients before and after hemodialysis. Methods Fifty patients with MHD were enrolled in our hospital in 2013 and divided randomly into HD group (n=25), and HFD group (n=25). Serum CRP, IL-6, TNF-α, and BNP were measured in patients before and after the first hemodialysis session and after the treatment for 6 months later. Results Serum CRP, IL-6, and TNF-α in HD group after the first dialysis session and after the treatment for 6 months were statistically insignificant (P>0.05). In HD group, serum BNP was decreased after the first hemodialysis session and the treatment for 6 months later, the decreases was statistically significant (P 0.05). However, after the 6 mouths, the decreases were statistically significant( P<0.05). Serum BNP was decreased after the first hemodialysis session and the treatment for 6 months later, the decrease was statistically significant(P<0.01). Between two groups, the different time-point and the interaction of two groups and the different time-point, the discrepancy above them were statistically significant(P<0.01). Conclusions The high-flux hemodialysis can eliminate more inflammatory factors such as CRP, IL-6, TNF-α, and serum BNP in patients with uremia. Serum BNP Helps to adjust the dry weight in time, relieve cardiac load and reduce the incidence of heart failure. High-flux hemodialysis is one of the ways of treatment that reduce the morbidity of the heart failure. It can improve prognosis of the patients with MHD. Key words: Renal dialysis; Uremia/TH/ME; C-reactive protein/ME; Interleukin-6/ME; Tumor necrosis factor-alpha/ME; Natriuretic peptide, brain/ME

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.

Effects of high-flux hemodialysis on FGF-23 and micro-inflammatory state in end-stage renal diseases patients

To explore the effects of high-flux hemodialysis (HFHD) on fibroblast growth factor 23 (FGF-23) and micro-inflammatory state in end-stage renal diseases (ESRD) patients to understand the advantages of HFHD in reducing complications in ESRD patients. A total of 60 subjects sheduled for hemodialysis at our hospital in 2012 were randomly divided into two groups of 3-month HFHD and 3-month low-flux hemodialysis (LFHD) (n = 30 each). The levels of serum factors, such as FGF-23, were observed before and after 3-month hemodialysis to evaluate the hemodialysis sufficiency of two groups and analyze the effects of FGF-23 related factors as well as different kinds of hemodialysis on microinflammatory state, biochemical indices and dialysis sufficiency. Before hemodialysis, no intergroup statistical difference (P > 0. 05) existed in age, gender, basic disease, nutrition and levels of hemoglobin (Hb), albumin (ALB), estimated glomerular filtration rate (eGFR), Ca2+,P3- parathyroid hormone (PTIH) and FGF-23 before treatment. After 3-month hemodialysis in two groups, there were a negative correlation between FGF-23, Ca2 + or 1, 25-(OH)2VitD3, a positive correlation between FGF-23 and ALB, P3-, PTH, C-reactive protein (CHRP) or interleukin-6 (IL-6l) and a negative correlation between FGF 23 and HFHD group (P <0. 05) and no significant correlation between FGF-23 and Hb or KT/V (P < 0. 05). Variance analyses were conducted for each factor before and after hemodialysis, indicating that Hb, ALB and Ca2+ significantly increased in both groups after 3-month hemodialysis (P <0. 05) and 1, 25-(OH)2VitD3 significantly elevated in HFHD group (P < 0. 05) but not in LFHD (> 0. 05 . Serum phosphate significantly decreased after 3-month hemodialysis in both groups (P <0. 05) and CHIP, IL-6l, PTH and FGF-23 significantly decreased in HFHD group (P <0. 05), but not in LFHD group (P >0. 05). The levels of P3-, CRP, IL-6, PTH and FGF-23 after 3-month hemodialysis were significantly lower in HFHD group than those in LFHD group (P <0. 05) while the levels of Hb and 1, 25-(OH)2VitD3 after 3-month hemodialysis were significantly elevated in HFHD group compared with those in LFHD group (P < 0. 05). And no significant inter-group difference existed in the levels of Ca2 ALB and KT/V. Compared with LFHD, HFHD is superior in treating anemia and improving nutrition. And HFHD can better decrease FGF-23, correct calcium and phosphorous metabolic disorder and improve micro-inflammatory state.

Efficacy and mechanism of hemoperfusion plus hemodialysis for peripheral neuropathy of uremic patients on maintenance hemodialysis

To explore the efficacy and mechanism of hemoperfusion (HP) plus hemodialysis (HD) for peripheral neuropathy of uremic patients on maintenance hemodialysis. A total of 66 uremic patients on hemodialysis during January 2014 and April 2011 were assigned randomly into HP+HD, low-flux HD and high-flux HD groups (n=22 each). The serum levels of leptin, endothelin-1 (ET-1), parathyroid hormone (PTH) and β-2 microglobulin were observed pre and post-treatment. And sensory conduction velocity (SCV) was detected simultaneously. After 12-week treatment, the clinical symptoms of group HP+HD improved significantly with an effective rate of 90.91% while improvement was not obvious in groups high-flux and low-flux HD with effective rates of 31.82% and 13.64%. In HP+HD group, the levels of leptin, ET-1, PTH and β-2MG decreased, sensory conduction velocity increased (P<0.05) and clinical symptoms improved apparently. While in low-flux HD and high-flux HD groups, leptin, ET-1, PTH and β-2MG had no decrease and SCV showed no improvement (P>0.05). Correlation analysis showed that the levels of leptin, ET-1 and β-2MG were negatively correlated with SCV (r=-0.57, r=-0.47, r=-0.56). Yet PTH had no correlation with SCV (r=-0.23). Hemoperfusion plus hemodialysis may improve the clinical symptoms of peripheral neuropathy of uremic patients on maintenance hemodialysis. And it is probably due to the fact that HP+HD effectively removes such plasma middle and macromolecular toxins as leptin, ET-1, PTH and β-2MG.

738 Impact of Serum Sodium Lowering on Systolic Blood Pressure in Hemodialysis Patients

Background: Since the procedure of hemodiafiltration (HDF) accompanies large amounts of ultrafiltration and substitution fluid infusion, the effects on body fluid compartments may be different from hemodialysis (HD). We compared serum sodiumand blood pressures between online-HDF and high-flux HD patients. Methods: Thirty-two out of 101 patients on high-flux HD were voluntarily switched to online-HDF. Their pre- and post-dialysis measurements were compared with the remaining 69 high-flux HD patients Results: The online-HDF group had lower pre- and post-dialysis systolic blood pressures compared with the high-flux HD group (pre-dialysis, 136 + 21 vs. 145 + 19 mmHg, P < 0.05; post-dialysis, 129 + 22 vs. 142 + 25 mmHg, P < 0.05). Pre- and post-dialysis serum sodium concentrations were not significantly different between the online-HDF and high-flux HD groups (pre-dialysis, 138 + 2 mEq/L vs. 137 + 3 mEq/L; post-dialysis, 134 + 2 vs. 134 + 2 mEq/L). However, the decrease in serum sodium concentration was larger in the online-HDF compared with the high-flux HD (3.7 vs. 2.5 mEq/L,P < 0.05). As serum sodium concentration decreased after the dialysis session, pre-dialysis systolic blood pressure (r = 0.317, P < 0.005) and pulse pressure (r = 0.324, P = 0.001) were significantly lowered. The serum sodium lowering also positively correlated with post-dialysis systolic blood pressure (r = 0.304, P < 0.005) and pulse pressure (r = 0.299, P < 0.005). Conclusions: Compared with high-flux HD, online-HDF has a larger serum sodium lowering effect. This may contribute to stabilizing both pre- and post-dialysis systolic blood pressures.

Equal levels of blood pressure control in ESRD patients receiving high- efficiency hemodialysis and conventional hemodialysis

The present study compared the status of hypertension and adequacy of blood pressure control in 73 end-stage renal disease (ESRD) patients treated with four different modalities of hemodialysis, namely, conventional hemodialysis (CHD) with cuprophan 1.1 m2 at a blood flow rate of 300 mL/min, high-efficiency hemodialysis (HED) with cuprophan 1.6 m2 at a blood flow rate of 450 to 500 mL/min, high-flux hemodialysis (HFD) with F80 polysulfone 1.8 m2 at a blood flow rate 500 mL/min, and high-flux hemodiafiltration (HDF) with F80 2 x 1.8 m2 in series at a blood flow rate of 600 to 650 mL/min. Thirty of the 73 patients (41%) were receiving one or more antihypertensive agents to control their hypertension. The percentage of patients taking antihypertensive medication was less in the groups treated with HED, HFD, and HDF compared with the CHD group: 38%, 39%, and 39%, respectively, in the HED, HFD, and HDF groups versus 56% in the CHD group. Control of systolic and diastolic hypertension was achieved in a higher percentage of patients treated with HED, HFD, and HDF compared with patients treated with CHD. Sixty-two percent of HED, 58% of HFD, and 61% of HDF patients compared with 44% of CHD patients had systolic blood pressure less than 150 mm Hg, whereas 77% of HED, 76% of HFD, and 78% of HDF patients compared 56% of CHD patients had diastolic blood pressure less than 90 mm Hg. However, the differences in the use of antihypertensive medication and control rates of hypertension did not reach statistical significance. The average blood pressure of all patients was 144/89 mm Hg; this did not differ significantly between the four groups. There also were no significant differences in etiology of ESRD, hematocrit, biochemical data, as well as use and dose of recombinant human erythropoietin between the four groups. Compared with the CHD patients, the average treatment times with high-efficiency treatments were shorter, with HDF patients showing the shortest mean treatment time of 157+/-41 minutes per hemodialysis session. The mean Kt/V was higher in the groups treated with HED, HFD, or HDF (1.31+/- 0.3, 1.30+/-0.4, and 1.43+/-0.3, respectively) than in the CHD group (1.12+/-0.3; P < 0.05). Interdialytic weight gain also did not differ among the four groups. There was no correlation between predialysis mean arterial pressure and either treatment time (r = 0.04, P = NS), Kt/V (r = 0.03, P = NS), ultrafiltration rate (r = 0.06, P = NS), or interdialytic weight gain (r= -0.08, P = NS). There also was no significant association between Kt/V and use of antihypertensive medications (chi-square = 1.76, P = NS). There was, however, a significant positive correlation between interdialytic weight gain and treatment time (r = 0.33, P < 0.01). We conclude that the use of short dialysis sessions with efficient hemodialysis treatments, namely, HFD and HDF, was associated with similar levels of blood pressure control in ESRD patients. (Am J Kidney Dis 1998 Apr;31(4):618-23)