| Objectives This article is to study the effects of hemodiafiltration(HDF)on the nutritional status,toxin clearance,complication rate,and mortality of hemodialysis(HD)patients,as well as their impact on patient benefits under different frequencies of use.With a view to providing the most economical and effective maintenance dialysis treatment mode under the current social conditions in China.Methods Collected clinical data of 90 patients who started maintenance hemodialysis at the Blood Purification Center of The First Affiliated Hospital of Dalian Medical University from June 2012 to June 2018.The clinical data of these patients were collected before the first dialysis and before the last dialysis in December 2019(dead patients were collected before the last dialysis).There were 55 males and 35 females,aged 29-86 years.The primary disease was chronic glomerulonephritis(n=39),diabetic nephropathy(n=22),benign renal arteriosclerosis(n=16),polycystic kidney(n=8),Ig A nephropathy(n=4),gout nephropathy(n=1).According to the dialysis mode,patients were divided into two groups: hemodialysis group(HD group)and hemodiafiltration group(HD + HDF group).According to the frequency of HDF treatment,the HD +HDF group is subdivided into HD + HDF1 group,HD + HDF2 group,HD + HDF3 group.Vascular access is arteriovenous fistula,standard internal fistula puncture.Use low molecular weight heparin or conventional heparin for anticoagulation.The nutritional status(hemoglobin,serum albumin),toxin clearance(urea nitrogen,creatinine,serum calcium,serum phosphorus,β2 microglobulin)was measured and incidence of complications and mortality were recorded by researchers for comparison.)Statistics were processed using SPSS23.0 software.All measurement data are expressed as mean ± standard deviation(X ± S),and comparison between the two groups uses t test.Count data were analyzed by Chi-square test(X2),and death caseswere analyzed by Logistic regression.P <0.05 was statistically significant.Results After long-term regular treatment of the corresponding dialysis mode,the nutritional status: before the last dialysis,the hemoglobin of the HD + HDF group rose to 112.87 ± 13.00 g / L,and the albumin rose to 40.53 ± 3.73 g / L,which was better than the HD group(P <0.05).HD + HDF subgroups were better than HD group in nutrition index(P <0.01).Dialysis effect: The levels of serum creatinine,urea,and blood calcium were not significantly different between the two groups before the last dialysis.HD +HDF group had blood phosphorus(1.39 ± 0.37 mmol / L)and β2 microglobulin(2.53 ±0.48 mmol / L).)Compared with HD group(P <0.05).In the HD + HDF subgroups,before the last dialysis,the blood calcium level in the HD + HDF1 group was 2.39 ±0.24 mmol / L,which was significantly higher than that in the HD group(P <0.05);the blood phosphorus levels in the three subgroups were lower than in the HD group(P<0.05).Complications: The common complications in this study were infectious events(58.9%),acute cardio-cerebrovascular events(16.7% + 13.3%),hypotension during dialysis(28.9%),hypertension during dialysis(15.6%),Gastrointestinal bleeding(6.7%),with respiratory infections being the most common infectious event.In terms of the incidence of complications,the HDF group was lower than the HD group(P=0.04),and there was no significant difference in the incidence of complications between the subgroup and the HD group.The incidence of acute cardiovascular events and infection in HD + HDF group was lower than that in HD group(P <0.05).The incidence of infectious events in HD + HDF subgroups was lower than that in HD group(P <0.05),and there were no differences in other complications.Mortality: The total mortality rate is 18.9%.Among them,the HD group was 36.8%;the HD + HDF group was 5.8%.There was a significant difference in mortality between the two groups(p <0.01).The main causes of death were heart failure,cerebral hemorrhage,and infection.Analysis of death factors: It was found that in the death group,the age of the patients(64.22 ± 10.25 years)was higher than the non-death group(56.69 ± 10.87years).The proportion of diabetic nephropathy(47.1%)was higher than that of the non-death group(19.2%).The levels of albumin and hemoglobin were lower than those in the non-dead group,and whether they were combined with HDF was statistically different(see Table 9 for details).The above independent variables were included in the logistic regression model.Compared with the HD model,the risk of death in the HD +HDF dialysis model was 0.1times(P<0.01,OR=0.1,95%CI:0.03-0.38).Conclusions 1.The combination of HD+HDF has clinical benefits,and it is possible to improve the prognosis of patients by removing large and uremic toxins to a greater extent.2.When the application frequency of HDF is not less than once every 3 months,it seems that dialysis patients can benefit from nutritional status,toxin clearance,complication rate,and mortality,and as the frequency of HDF increases,The benefit may be greater. |
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