Clinical Studies On Effect Of FX-class High Flux Hemodialysis On Improving The Life Quality Of Uremic Patients

Part I The studies on effect of FX-class high flux hemodialysis on toxin clearance,anemia, secondary hyperthyroidism, calcium and phosphorus metabolism, ET-1,NO,MAP of uremic patientsObjectivethe aim of this study was to compare the effects of high flux hemodialysis and low flux hemodialysis on toxin clearance,anemia, secondary hyperthyroidism, calcium and phosphorus metabolism, ET-1,NO,MAP of patients with maintenance hemodialysis. From this point of view, how to effectively remove the middle and large molecules from patients with uremia has important clinical significance. At present, many clinical data show that, high flux hemodialysis can better remove the large molecules from the body of patients with uremia. However, there are not enough data show that the clearance of the large molecules can effectively improve the complications of patients with uremia. Therefore, in view of the problems, this paper mainly starts from the following several aspects, namely high flux hemodialysis on toxin clearance,anemia, secondary hyperthyroidism, calcium and phosphorus metabolism, ET-1,NO,MAP.MethodsThis paper selects 42 cases of uremic dialysis patients in the third Affiliated Hospital of Anhui Medical University from 2011 October to 2012 June. And 21 patients were randomly assigned to the low flux dialysis group, while another 21 patients were allocated to high flux dialysis group. In addition, we also selected 24 cases of healthy normal control group. Helixone polysulfone dialyzer Fx60 was used in high flux dialysis patients, while the low flux dialysis group was using F7. All patients were dialyzed three times a week, with 4-4.5 hours per time. And dialysis time was more than three months, with stable disease. And in the process of dialysis, uremic patients had not received blood transfusions or immunosuppressive therapy, as well as traumatic operation. Before and after a single dialysis of high flux dialysis group and low flux hemodialysis, patients blood samples were extracted, with 5 ml of each sample. In addition, we also collected fasting blood samples of healthy people. Then, we put these extracted blood specimen for-80~-20 oC preservation.The blood samples were centrifuged, and we analyzed the following molecular in high flux dialysis group and low flux hemodialysis patients, such as serum urine(BUN), phosphorus(P3+), parathyroid hormone(intact parathyroid hormone, i PIH), β 2- microglobulin(β 2-microglobulin, β 2-MG) level. And then, we explore the effect of high flux dialysis on toxin clearance. In addition, we also compared the hemoglobin(Hb), hematocrit(Hct), serum albumin(ALb), serum creatinine(Scr) levels in vivo in patients with HFHD and LFHD. Then, we study the effect on the improvement of anemia. According to the change levels of blood calcium, phosphorus, parathyroid hormone, we investigate the effect of high flux hemodialysis on secondary hyperparathyroidism, calcium and phosphorus metabolism. Moreover, we also compared the levels of ET-1,Ang II,NO and the blood pressure of the high flux dialysis patients.Results1.After treatment of the high flux dialysis, the patient’s BUN, Scr, albumin, serum phosphate, β2-MG decreased significantly. Therefore, compared with the conventional low flux hemodialysis, high flux dialysis not only clear small molecular substances, and is better able to scavenge i PTH, β 2-MG and other large, middle molecular(P<0.05)2.After 6 months later of the high flux dialysis, the patient’s hemoglobin(Hb), hematocrit(Hct) were significantly higher than that of the conventional hemodialysis group(P<0.05).3.After 6 months later of the high flux dialysis, serum phosphorus, serum calcium, parathyroid hormone in patients decreased. Compared with the low flux hemodialysis, our data suggest that high flux dialysis can more effectively remove blood parathyroid hormone. Moreover, the difference is statistically significant(P<0.05).4.After 6 months later of the high flux dialysis, the level of ET-1 in patient was decreased and the blood level of NO can be improved(P<0.05).Conclusion1. Cmpared with the conventional low flux hemodialysis, high flux dialysis is better able to scavenge P3+,i PTH, β 2-MG.2. Wth the use of high flux dialysis, anemia in uremic patients was obviously improved.3. High flux hemodialysis can make the uremia patients with hyperparathyroidism symptoms effectively controlled.4. Through high flux dialysis, ET-1, NO molecules can be effectively removed, and then improve the functions of vascular endothelial cells, which is beneficial to control the blood pressure of patients.Part II The studies on effect of FX-class high flux hemodialysis on malnutrition, inflammation, lung function,life quality score of uremic patientsObjectivethe aim of this study was to compare the effects of high flux hemodialysis and low flux hemodialysis on improving malnutrition, inflammation, arteriosclerosis and the improvement of lung function, life quality score of patients with maintenance hemodialysis.Compared with the low flux hemodialysis, high flux hemodialysis effectively promotes the removal of large and middle molecules by diffusion, convection and adsorption. However, there are not enough data show that the clearance of the large molecules can effectively improve the long-term complications of patients with uremia. Therefore, in view of the problems, this part mainly starts from the following several aspects, namely high flux hemodialysis on malnutrition, inflammation and the improvement of lung function,life quality score.MethodsThis paper selects 42 cases of uremic dialysis patients in the third Affiliated Hospital of Anhui Medical University from 2011 October to 2012 June. And 21 patients were randomly assigned to the low flux dialysis group, while another 21 patients were allocated to high flux dialysis group. In addition, we also selected 24 cases of healthy normal control group. Helixone polysulfone dialyzer Fx60 was used in high flux dialysis patients, while the low flux dialysis group was using F7. All patients were dialyzed three times a week, with 4-4.5 hours per time. And dialysis time was more than three months, with stable disease. And in the process of dialysis, uremic patients had not received blood transfusions or immunosuppressive therapy, as well as traumatic operation. Before and after a single dialysis of high flux dialysis group and low flux hemodialysis, patients blood samples were extracted, with 5 ml of each sample. In addition, we also collected fasting blood samples of healthy people. Then, we put these extracted blood specimen for-80~-20 oC preservation.The blood samples were centrifuged, and we analyzed the following molecular in high flux dialysis group and low flux hemodialysis patients, such as serum albumin(ALB) level. At the same time, through the determination of SGA,TSF,MAC,MAMC,blood fat,C-reactive protein(CRP), interleukin-6(IL-6) and concentration in patients, we study whether high flux dialysis can improve the malnutrition and micro inflammatory reaction in dialysis patients. In addition, since the lung is one of the most commonly involved organs of uremia, pulmonary function in patients with uremia may be affected by many factors. In this study, by comparing the pulmonary function of the low flux hemodialysis patients and high hemodialysis patients, we try to investigate the effect of high flux hemodialysis on pulmonary function in patients with uremia. To evaluate the effect of high flux hemodialysis on the quality of life in patients with uremia, we also used the SF-36 scale to assess patients’ physiological and psychological status.Results1.After 6 months later of the high flux dialysis, the patient’s serum albumin 、TSF、MAMC and HDL levels were enhanced, while CHOL, TG, LDL levels decreased(P<0.05). Therefore, high flux dialysis can improve the nutritional status of patients. Moreover, 6 months later, the patient’s IL-6 level decreased significantly(P<0.05).2.After 3 months later of the high flux dialysis, pulmonary function were improved to some extent. The values of FVC, MBC, FEV1, FEF, MMEF, V25, DLCO in observe group and control group were lower than those in normal group(P<0.05). Compared to before treatment, the values of FEV1, FEF, MMEF, V25 increased significantly(P<0.05), and FVC, MBC, DLco were no significant change in observe group and control group after treatment(P>0.05). The change range of FEV1, FEF, MMEF, V25 in observe group was more than those in control group(P<0.05), and FVC, MBC, DLco had no significant differences between groups(P>0.05).3. After 6 months of the high flux dialysis, the life quality score s of PCS, PF, RP, BP, RE were significantly higher than that before treatment, with statistical significance. But MCS, GH, SF, MH, VT scores did not change significantly before and after treatment.Conclusion1. High flux dialysis can improve the patient’s state of Malnutrition and inflammation. Since inflammation is closely associated with atherosclerosis, therefore, high flux dialysis can improve vascular sclerosis to the certain extent.2. The function of pulmonary ventilation and diffusion decreased in patients with renal failure accompanied with airways obstruction. High-flux hemodialysis can improve airways obstruction remarkably, but it has no effect on the function of pulmonary ventilation and diffusion.3. The quality of life score was improved among patients with uremia through high flux dialysis.