| Objectives1.To compare the effects of three different modes of blood purification,hemodialysis(HD),hemodialysis combined with hemodialysis filtration(HDF),and hemodialysis combined with hemodialysis filtration combined with hemodialysis perfusion(HP),on end-stage renal disease(End-stage renal The effects of three different hemodialysis modalities,including N-terminal probrain-B-type natriuretic peptide(NT-proBNP)and heart failure(HF)in patients with end-stage renal disease(ESRD).2.To analyze the relationship between NT-proBNP and the occurrence of heart failure and to assess the predictive value of NT-proBNP on the occurrence of heart failure in patients with end-stage renal disease.MethodsNinety ESRD patients undergoing regular maintenance hemodialysis were selected and divided into three groups: group A was hemodialysis(HD)treatment group,group B was hemodialysis combined with hemodialysis filtration(HD + HDF)treatment group,and group C was hemodialysis combined with hemodialysis filtration combined with hemoperfusion(HD + HDF + HP)treatment group.All patients’ general information such as gender,age,dialysis age and primary disease were collected,and blood NT-proBNP,creatinine(Cr),burea nitrogen(BUN),creatine kinase isoenzymes(CK-MB),and The results of the study were as follows: Cardiac troponin T(c Tn T),and Left Ventricular Ejection Fraction,(LVEF)、Left ventricular posterior wall(LVPWT)、Left ventricular end-diastolic diameter(LVDd)、Left ventricular end-diastolic volume(LVVd)and Left ventricular end-systolic volume(LVVs)),were measured by follow-up.The occurrence of heart failure in all patients within 12 months after treatment was counted by follow-up.SPSS 26.0 statistical software was used for data analysis.Results1.There was no statistically significant difference between the three groups A,B and C in general condition and each clinical index at baseline(P > 0.05),which was comparable.2.After 3 months of treatment,NT-proBNP in group A increased compared with that before treatment,and that in groups B and C decreased compared with that before treatment.By comparing the difference between before and after treatment,the difference between NT-proBNP before and after treatment was larger in groups B and C than in group A(P <0.05),and there was no significant difference between groups B and C(P > 0.05).3.After 3 months of treatment,the clinical indexes such as Cr,BUN,CK-MB and c Tn T decreased in all three groups compared with those before treatment,and further comparison of the difference between the post-treatment values of each index showed no statistically significant difference(P > 0.05).4.After 3 months of treatment,LVEF in group A decreased and LVPET,LVDd,LVVd,and LVVs increased compared with those before treatment,while LVEF and LVPET in groups B and C increased and LVDd,LVVd,and LVVs decreased compared with those before treatment;when comparing the difference values of each index before and after treatment,the difference values of LVEF and LVVs in group C were different from those in groups A and B(P < 0.05),and the difference of LVVd in groups B and C was different from that in group A.The differences of the remaining indexes were not statistically significant(P > 0.05).5.90 patients were followed up and the occurrence of heart failure was counted,and the difference in the occurrence of heart failure among the three groups was statistically significant(P < 0.05).the occurrence of heart failure in groups B and C was significantly less than that in group A.6.All patients at the beginning of the group were divided into HF group and no HF group according to whether or not heart failure occurred.The NT-proBNP level in the HF group was significantly higher than that in the no HF group,and the LVEF level was lower than that in the no HF group,but there was no significant difference in the rest of the indexes(P > 0.05).7.Patients’ NT-proBNP levels were positively correlated with c Tn T(r = 0.344,P < 0.05),LVDd(r = 0.033,P < 0.05),and LVVs(r = 0.291,P < 0.05)levels(r = 0.4;P < 0.05),and negatively correlated with LVEF values(r =-0.404,P < 0.05);there was no correlation with other There was no correlation with other index values(P > 0.05).8.Further analysis revealed NT-proBNP as an independent risk factor for the development of heart failure(OR = 1.113,95% CI: 1.061-1.167,P < 0.05).9.The AUC of NT-proBNP to predict the occurrence of heart failure was 0.852 by ROC curve,and the specificity and sensitivity were 82.8% and 76.9%,respectively,and the calculated optimal cut-off value was 11656 pg/ml.Conclusion1.HD + HDF and HD + HDF + HP modes can reduce NT-proBNP levels,improve patients’ cardiac function and reduce the occurrence of HF in ESRD patients compared with HD mode.HD + HDF + HP has a greater effect on patients’ cardiac function compared with HD + HDF,but the difference in the occurrence of HF in patients treated with both modes is not significant.2.NT-proBNP level was closely related to the cardiac function of ESRD patients,and NT-proBNP was an independent risk factor for the occurrence of HF in ESRD patients.NT-proBNP has an independent predictive value for the occurrence of HF,and when NT-proBNP > 11656pg/ml,patients have a high possibility of heart failure. |
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