| Objective:Exploring the difference between conventional hemodialysis and combined with hemodiafiltration to treat uremia patients in the respect of dialysis adequacy, we can compare the advantages and disadvantages between them through toxin elimination, the balance of biochemical index, cardiovascular function improvement and long-term complications. Ultimately, the object of achieving optimization of patients can be realized through choosing more efficient ways to guide the clinical treatment.Methods:(1) Collecting 66 cases of chronic renal failure uremia patients who were given long-term maintenance of hemodialysis therapy during the period from January 2001 to January 2015 in the blood purification center of Qilu Hospital of Shandong University, then according to the way of dialysis, we assigned them into two groups, Group A:conventional hemodialysis group (HD group, n=40), three times a week, each time 4h. Group B:Hemodiafiltration group (HDF group, n=26), one time of HDF on the basis of three times of HD a week, each time 4h. (2) These patients blood samples were taken before dialysis respectively after regular blood purification treatment for 12 months, with the detection index including serum creatinine(Scr), blood urea nitrogen(BUN), blood urea(BUA), calcium(Ca2+) and phosphorus(P3+), parathyroid hormone(PTH), beta-2 microglobulin(β2-MG), C-reactive protein(CRP), hemoglobin(Hb) and albumin(ALB). At the same time, with the aid of Doppler echocardiography examination, we could measure the left ventricular ejection fraction (LVEF) and calculate the left ventricular mass index (LVMI) according to the thickness of atrium and ventricle. Later, the comparison about the above data between before and after treatment of different and same groups was formed. In addition, we could compare the discrepancy of the sum of urea clearance index (Kt/V) all times of a week through calculation method. Excluding the accident causes, we summarized the occurrence frequency of complications and recorded the total deaths of patients enrolled in regular treatment during one year time in order to find the difference between the two groups. (3) Using SPSS 19.0 software to analysis, the count data between two groups were compared in X2 test and the measurement data that meet normal distribution were compared in t test, otherwise compared in the nonparametric test, P<0.05 means there had statistically significant difference.Results:(1) The blood sample tests showed the levels of Cr, BUN, BUA and other small molecule toxins in all patients who had given one year regular treatment were lower than the stage of pre-treatment, and in this respect, the HDF group was more significant than HD group(tScr=3.361, tBUN=4.359, tBUA=4.174, P< 0.05). (2) These two treatments could correct Ca2+, P3+metabolic disorder and clear the PTH, beta 2-MG and other large molecular toxins, but the HDF group was a more remarkable role(tca2+=-3.826, tP3+=6.380, tPTH=2.259, tβ2-MG=9.775, P< 0.05). (3) As far as one single dialysis Kt/V was concerned, the HDF group was lower than the HD group (t=5.926, P< 0.05), but in terms of the adequacy of a week of dialysis, the sum of Kt/V all times of a week in HDF group was significantly higher than the HD group(t=-2.231, P< 0.05), and the difference had statistically significant. (4) The Hb and ALB concentrations were more markedly higher than the stage of pre-treatment in all patients, and the levels of HDF group were more significant than the HD group(tHb=-3.117,tALB=-2.061, P< 0.05). The factor of CRP in all patients, which is associated with anemia and represents the micro-inflammatory state of the body, was higher than the stage of pre-treatment, while the HD group had a obvious upward trend(t=2.510, P< 0.05). (5) The HDF group had more advantages in improving the heart function, and there was no significant difference in the HD group compared with the stage of pre-treatment(P*> 0.05). (6) During the regular dialysis treatment, the skin itching of HDF group was improved significantly(P< 0.05), however, due to the small patients in all the group, although the incidence of cardiovascular disease, infection, uremic encephalopathy, death and other complications in the HDF group were lower than the HD group, the difference had no statistically significant.Conclusion:The treatment of one time of HDF on the basis of three times of HD has more advantages than simple three times of HD a week, and it is mainly reflected in the following aspects:(1) With a higher dialysis adequacy, it can completely clear the toxin molecule and maintain low levels in the blood. (2) It can obviously alleviate the micro-inflammatory state and improve nutritional status of the body. (3) It can significantly improve the patient’s cardiac function and delay its deterioration. (4) It can reduce the incidence of complications, enhance the quality of life of patients and improve the outcomes. |
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