| Objective:To study the influence of the two ways of hemodialysis and hemodiafiltration to maintenance hemodialysis patients nutritional stauts, parathyroid hormone, β2-microglobulin, micro-inflammatory status (high sensitive C reactive protein), complication and turnover.Methods1.80cases with maintenance hemodialysis patients are divided into two groups, each of the40cases. Every time of dialysis last4hours. Group of A:conventional hemodialysis,3times per week. Group of B:hemodialysis treatments,3times per week, two of that is HD, one of that is HDF.2. index detection:(1)index of nutritional status:improved SGA, BMI、ALB、 Hb、BUN、Scr、Leptin.(2) complication:partly record frequencies of A and B groups in hypertention、hypotension、arrhythmia、angina、infection and muscle spasm.(3)Kt/v.(4) hs-CRP.(5) β2-MG.(6) PTH.(7)1detected the above observed projects in six months and twelve months and record numbers and cases of death patients.3.statistical treatment:apply SPSS19.0statistical analysis software processing. All measurement data indicated using mean±standard deviation (X±S).Comparison between groups used t test. Multiple variables was compared by using one-way analysis of variance (ANOVA). Enumeration data indicated by using chi-spuare test.Cases of death were analysised by logistic regression.It is statistical significance when P<0.05.Results1. Chronic glomerulonephritis and diabetic nephropathy are mostly seen in two groups. Comparing age is no significant difference. 2. Nutritional status:In aspect of improved SGA there is significant difference between group of A2(14.95±3.01) and B2(12.25±3.30) after twelve months (F=7.277, P<0.05). In aspect of weight (Kg) there is significant difference between group of A2(59.05±11.06) and B2(65.93±9.33)(F=4.512, P<0.05). In aspect of BMI there is significant difference between group of A2(20.96±2.62) and B2(23.75±3.38)(F=8.499, P<0.01). Inaspect of Hb (g/L) there is significant difference between group of A2(99.05±11.98) and B2(110.15±7.11)(F=12.683, P<0.01). In aspect of ALB (g/L) there is significant difference between group of A2(38.10±1.90) and B2(40.56±2.22)(F=14.048, P<0.01). In aspect of Leptin(ug/L) there is significant difference between group of A2(12.32±2.58) and62(10.81±1.69)(F=4.755, P<0.05). In aspect of SCr(umol/L) there is no significant difference between group of A2(601.75±104.83) and B2(585.22±133.93)(F=0.189, P=0.666). In aspect of BUN (mmol/L) there is no significant difference between group of A2(23.32±3.92) and B2(21.30±3.80)(F=2.748, P=0.106)3. complication: Acute complications were2932times during the process of dialysis, total incidence is26.16%. Group A1928times, a rate of35.31%;group B1004times, a rate of17.46%. There is significant difference by using chi-spuare test (x2=461.54, p<0.001). Infection wer146times. Cases in A group is92times(63.01%).There were57times of pulmonary infection,5times of vascular access infection,9times of digestive tract infection,21times of urinary tract infection. Cases in B group is54times(36.98%). There were33times of pulmonary infection,5times of vascular access infection,4times of digestive tract infection,12times of urinary tract infection.4. Kt/v:There were no significant difference between group of A2(1.28±0.12) and B2(1.30±0.08)(F=0.0370, P=0.546)5. hs-CRP:there is significant difference between group of A2(4.74±4.02) and B2(2.03±0.93) after twelve months (F=8.604, P<0.05)6.β2-MG:there is significant difference between group of A2(23.36±5.94) and B2(18.28±4.99) after twelve months (F=8.567, P<0.05)7. PTH:there is significant difference between group of A2(706.05±290.04) and B2(434.74±289.73) after twelve months (F=8.759, P<0.01)8. turnover:After one year, cases of death in group A is five times, one of them is cerebral hemorrhage, three is heart failure, one is sudden death. There are no death cases in group B. The mortality rate is6.25%. There were significant different by using chi-spuare test (x2=5.33, p<0.05). Logistic regression analysis revealed that death rate was negative correlated to Hb and ALB, Hb、ALB the higher, the mortality rate is lower.Conclusion:1. HDF can improve the nutrition of patients.2. There is no significant difference between HD and HDF in the removal of the small molecules and improving of Kt/V.3. The patients of group B improved nutritional status and enhanced immunity after HDF treatment, so dialysis complications and the risk of infection are reduced greatly.4. HDF can effectively remove the middle molecular substance, include CRP、32-MG、PTH.It can reduce chronic MHD patient complications and improve the quality of life.5. The mortality rate is decreased obviously after HDF treatment. Death rate was negative correlated to Hb and ALB in MHD patients, Hb、ALB the higher, the mortality rate is lower. |
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