关键词:  双重血液滤过, 无透析液的血液透析滤过, 高容量血液滤过, 清除率, 中分子溶质

Abstract:

ABSTRACT objective: To design two novel modes of continuous renal replacement therapy (CRRT) and compare the capability of clearance of solutes by two ways of CRRT. Methodology: Forty patients with renal failure receiving extended hemodialysis were enrolled into this prospective randomized controlled study from September 2013 to Febrary 2014. They were randomly divided into four groups (each group, n=10): standard volume hemfiltration (SVHF), HVHF, double hemofiltration (DHF) or dialysate-free hemodiafiltration (DF-HDF). The effulent fluid in four groups were 35ml/(kg.h), 100ml/(kg.h), 35ml/Kg/h and 30ml/(kg.h), respectively. The specimens of blood and effulent fluid were collected at the first hour after start of blood purification, and the clearances of β2-microglobunlin, cystatin C, creatinine, trace element, hemocyseine and other solutes were calculated. Results: They were 21 males and 19 females with a mean age of 44.8 years old. The clearance of creatinine by SVHF, HVHF, DHF, DF-HDF were 30.1±2.0ml/(kg.h), 69.0±7.2ml/(kg.h), 32.3±4.2ml/(kg.h), 32.1±3.4ml/(kg.h), respectively, and the clearance of creatinine by DHF, DF-HDF were significantly inferior to that of HVHF (P<0.05) and not superior to that of SVHF. The clearance of β2-microglobunlin by SVHF, HVHF, DHF, DF-HDF were 16.1±2.8ml/Kg/h, 35.0±7.5ml/(kg.h), 40.8±9.9ml/(kg.h), 35.8±10.6 ml/(kg.h), respectively, and the clearance of β2-microglobunlin by DHF, DF-HDF were not inferior to that of HVHF and were superior to that of SVHF (P<0.05). No severe adverse effects were observed in the duration of treatment. Conclusion: DHF and DF-HDF increase the removal of middle molecular solutes compared to SVHF and decrease the removal of small soluble solutes compared to HVHF.

Key words: double hemofiltration, dialysate-free hemodiafiltration, high volume hemofiltration, clearance, middle molecular solutes