Influences Of Long-term Of Different Dialysis Frequencies Per Week To The Patients With Maintenance Hemodialysis

Objective:To study the influence of different dialysis frequence to maintenance hemodialysis patients nutritional status,residual renal function(RRF),complication,uea clearance divided by volume of distribution(Kt/v),micro-inflammation state and turnover.Methods1.A total of 53 chronic renal failure patients with maintenance hemodialysis were recruited.All patients were divided into 3 groups.Patients in groups A dialysed 3 times per week.Patients in groups B dialysed twice per week.Patients in groups C dialysed 3 times each two weeks.All the groups were marked as A1,B1,C1 after dialysed for 1 year.Dialyser used F₆ polysulfone membranes,and every dialyse was repeatly used for 8 times.Every time of dialysis last 4 hours.2.index and method of detection:(1)index of nutritional status:improved SGA,BMI, Hgb,BUN,Scr and Leptin.(2) RRF.(3) complication:hypertension,infection,uremic encephalopathy,complication rate in dialysis(hypotension,hypertension,muscle spasm and arrhythmia).(4) Kt/V.(5) micro- inflammation state:hs-CRP,IL-6and TNF-α..(6) we detected all the index above 1 year later,and recorded the death number,death reason and exit information.3.statistical treatment:measurement data was demonstrated using means±SD. Comparison between groups used t test.Multiple variables was compared using one-way analysis of variance(ANOVA).Chi-square analysis was used to test numeration data.Cases of death were analysised by logistic regression.We considered that the difference was significantly when p＜0.05.Result:1.In the three groups major primary diseases are glomerulonephritis,diabetic nephropathy and innocence arteriosclerosis renal.2.Nutritional Status:In aspect of improved SGA there is significant difference between group of A1(14.47±3.34) and C1(18.36±6.80)(t=2.047,p＜0.05).In aspect of Hb(g/L) there are significant differences between group of A1 (83.59±12.34g/L) and B1(70.62±13.10g/L)(t=2.779,p＜0.01 ),and the same to A1 and C1(65.91±12.19g/L)(t=3.737,p＜0.001) BUN(mmol/L):There are significant differences in A1/C1(25.92±6.91/29.33±9.68,t=2.320,p＜0.05) in aspect of BUN.Cr(umol/L):Cr were higher in group of A1(970±212) than C1 (1163±341)(t=2.157,p＜0.05 ).ALB(g/L):there is significant difference between group of A1(38.27±3.26) and C1(36.14±4.91)(t=-3.715,p＜0.05). Leptin(ug/L):there are significant differences between group A(10.40±6.60) and A1(12.99±6.16)(t=-3.342,p＜0.005),B(8.91±4.06) and B1(12.19±5.73)(t= -2.976,p＜0.05),C(10.81±5.01) and C1(17.89±9.54)(t=-2.287,p＜0.05), and the same to group A1 and C1(t=4.327,p＜0.01).All these result suggest that Leptin maybe rise along with time to extend.3.RRF(ml/min):RRF in group of A,B and C were 6.48±1.72,6.98±2.17,5.99±2.42。RRF in group of A1,B1 and C1 were 2.76±1.45,3.27±1.77,4.07±2.55。After dialysis for 1 year,RRF in group of A,B and C all descented obviously(t=9.605, p＜0.001;t=8.393,p＜0.001;t=12.026,p＜0.001 ),there is significant difference between group A1 and C1(t=2.416,p＜0.05).RRF in group of C decreased least.4.complication:incidence rate of hypertension in A group was 84.2%,in B was 86.7%and in C was 94.7%.the control rate were 87.5%,84.6%and 66.7%to part.C group had the highest incidence rate of hypertension,and A group had the lowest one.A group had the highest control rate of hypertension,and C group had the lowest one.there were 3 patients with uremic encephalopathy and these patients all were in group of C.Infection:All the cases wre to be infected for 62 times.There were 35 times of pulmonary infection,14 times of blood vessels infection,8 times of urinary tract infection,5 times of digestive tract.Cases in A group infected 17 times, 18 times as to B group and 18 times for C group.C group had the highest infection rate.dialysis complications:All the 53 cases take hemodialysis for 5240 times.Acute dialysis complication took place for 2779 times.the total incidence rate was 51.3%. incidence rate of A was 36.7%,B was 54.0%and C was 82.7%.total hypotension rate was 13.7%.hypertension rate was 25.3%.muscle spasm rate was 8.47%.arrhythmia rate was 3.75%.5.Kt/v:there were no significant difference of Kt/among A,B and C,and the same toA1,B1 and C1.6.micro-inflammation state:In aspect of hs-CRP(mg/L) there was significant difference between group A1(9.34±5.99) and C1(13.9±9.68)(t=5.733,p＜0.05). IL-6(pg/ml):There was significant difference between group of A1(113.4±61.2) and C1(135.8±69.8)(t=3.757,p＜0.05).There were no significant difference of TNF-αamong A,B and C(F=22.35,p=0.762),and the same to A1,B1 and C1(F=28.31, p=0.546).7.turnover:the total deaths rate was 15.1%.1 case died in A(5.3%),1 case died in B(6.7%) and 6 died in C(31.6%).x² test suggest that death rate was significant different(x²=6.293,p＜0.05 ).1 case in A group did kidney transplantation.1 case in B group gave up to treat.2 cases in C group gave up to treat.Logistic regression analysis revealed that death rate was positive correlated to improved SGA,and negative correlated to Hb and ALB.Conclusion:In three groups the major primary diseases are glomerulonephritis,diabetic nephropathy and innocence arteriosclerosis renal.Dialysis frequency was important factor to influence nutritional status(Hb,BUN,Cr,ALB and Leptin).C group had lower dialysis frequency,higher complication rate(hypertension,infection and uremic encephalopathy),and the micro-inflammation state was significantly.Complication rate in dialysis(hypotension,hypertension,muscle spasm and arrhythmia) and death rate of C group was higher.There was significant death rate was positive correlated to improved SGA,and death rate was negative correlated to Hb and ALB.There were no significant differences btween dialyse 2 times and 3 times per week as to nutritional status in short times.,remnant renal function,complications and death rate.The long-term influence need further observation.patients who dialyse 3 times each two weeks had higher rate of malnutrition,complication and death.we should adjust dialysis program and to increase dialysis frequencies.