Effect Of High-flux Hemodialysis On Nutritional Ststus Of ESRD Patients

Objective:Malnutrition is common in end stage renal disease(ESRD)patients,and it has a great impact on the quality of their life ,and strongly correlated with the morbidity and mortality.According to the previous reports,hemodialysis is not only a treatment for uremic patients to maintain their lives,but also has different impacets ontheir nutritional status.At present, most dialysis center use low flux filter,which is ineffective in clearing medium or large molecular weight toxins,and result in a higher incidence of malnutrition.The high flux dialyzer has greater ultrafiltration coefficient and adsorption capacity,it can clear inflammatory factors batter than low flux filter,this may lead to an improved appetite and a decreased micro-inflammatory state of the patients,and at last make the nutritional status improve.this sduty is in order to observe the effect of high flux hemodialysis on nutritional status of these patients .Methods: Selected all the 33 patients of ESRD in Dalian Central Hospital from Apr,1998 to Aug,2008,9 females(27%) and 24 males(73%),with the everage age of 42.39±10.70.Primary disease:21 patients are chronic glomerulonephritis ones, 8 patients have hypertension, 3 polycystic kidney disease, and 1 person diabetes, all of them have been receiving maintenance hemodialysis for 7 months.According to the length of time into the high-flux dialysis ,all the 33 patienta are put into before the high-flux dialysis group (first group), high flux dialysis 3 months group (group II), and high flux dialysis for 6 months group (Group III).Measured and detected their scores on subjective assessment of nutritional status (SGA), body weight, body mass index (BMI), biceps skinfold (BSF), triceps skinfold thickness (TSF), upper arm circumference (MAC), arm muscle circumference (AMC), prealbumin (PA), albumin (Alb), total cholesterol (CHOL), triglyceride (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL)respectively.Exclusion criteria were infection, the activity of autoimmune diseases (such as systemic lupus erythematosus), chronic wasting disease (such as tuberculosis, cancer, hyperthyroidism, etc.), active bleeding, receiving enteral or parenteral nutrition, placement of the heart Pacemaker,or the oral and injection drugs were significantly different during the 6 months.Results: (1)SGA score: no significant difference between the groups, both A-level,but after the 6 months' high flux hemodialysis treatment ,patients chose more"A" than before , and a increasing number of patients that selected the "significant improvement"option ;(2)Anthropometric indicators:For 6 months' high flux dialysis treatment , TSF, MAC measurements increased significantly (P <0.05), body weight, BMI, MAMC were no significant different between the groups, but the classification of malnutrition changed, more moderate malnutrition changed into mild malnutrition;(3)Biochemical detection of indicators: After 6 months' high flux dialysis treatment, serum ALB, HDL increased significantly, serum CHOL, LDL decreased significantly (P <0.05), PAB, TG was no significant different between the groups, PAB decreased at first, then has a upward trend.Conclusions: High-flux hemodialysis can improve appetite and may reduce the in micro-inflammation in uremia patients, then increase the protein intake and reduce protein catabolism ,and at last improve some nutritional parameters in uremic patients, also has a good role of adjustingt lipids catabolism .