The Influence Of On-line Hemodiafiltration With Different Dilution Modes And Ratio Solute Clearance

Objectives In this study, we mainly study the influence of on-line hemodiafiltration with different dilution modes and ratio(pre-dilution,post-dilution and mixed-dilution)solute clearance in patients undergoing the hemodialysis.Methods The90 uremic patients with regular hemodialysis treatment more than three months in MeiTan General Hospital Renal Departmentwere selected. The men was 55,women was35.The mean age was52±16.26 year,the dialysis years were 5.26±1.83.They randomly were divided into nine groups: A group:pre-dilution, B group : post-dilution, Cgroup: 1:1mixed-dilution, Dgroup: 1:2mixed-dilution, E group: 2:1mixed-dilution, F group: 1:4mixed-dilution, G group: 4:1mix-dilution, H group: 2:3mixeddilution, I group: 3:2mixed-dilution. There ten patients every group. The experimental conditions were same among the groups.The dialysis machine is Dialog+produced by Germerny. B.Braun company.Hemo-dialysor Hips15 was choosed, its Kuf is 50ml/h/mm Hg,the velocity of blood flow is 250ml/min, the velocity of dislysate is 500ml/min,the velocity of substitution was 60ml/min. Theindicator is serumcreatinine(Scr),blood urea nitrogen(BUN) and?2-microglobulin(?2-MG).Blood examples werebroughtto exam at time points: before dialysis,forty minutes after dialysis and after dialysis forfour hours.Statistical software is SPSS19.0, the date was expressed to be mean±standard deviation.Comparison between groups used One-Way ANOVA,the differenceofstatisticalsignificanceis P<0.05.Results Forty minutes after Hemodiafiltration, the BUNclearancein group(post-dilution33.69±5.45)was superiorto group( pre- dilution, 22.20±3.54) andgroups( mixed-dilutions,1:1group28.56± 6.30,1:4group27.34±6.13,2:3group28.41±3.88,1:group227.65±5.91,2:1group27.10±1.77,3:2group27.27±8.18,4:1group27.54±3.92)(P<0.05); the groups( mixed-dilutions) were superior to the one( pre- dilution)(P<0.05); Every group ofmixed-dilutions isnotstatisticaldifference(P>0.05). Theclearance of Scr in group(post-dilution, 31.99±4.20) is precede togroup(pre- dilution, 22.21±3.27)andgroups( mixed-dilutions, 1:1group26.74±5.86,1:4group26.98±5.45,2:3group27.52± 3.43,1:2group 27.66±5.77,2:1group26.90±3.16,3:2group26.34±5.42,4:1group27.35±2.33)(P<0.05); the groups( mixed-dilutions) were superior to group(pre- dilution)(P<0.05);Every group(mixeddilution) was notstatisticaldifference(P>0.05).Every group is not statisticaldifference for?2-MG.Four hours after Hemodiafiltration, the clearance of BUN in group( post-dilution, 24.71±2.81)andgroups(mixed-dilutions, 1:1group25.49±7.45,1:4group24.36±2.19,2:3group24.63±2.16,1:2group 25.29±3.19,2:1group23.99±2.61,3:2group23.61±2.33,4:1group24.26±2.75) wereprecede togroup(pre- dilution, 19.38±4.45)(P<0.05),but there was no difference between the group(post-dilution) and group( mixed-dilutions)(P>0.05). Every group(mixed-dilutions) were notstatisticaldifference(P>0.05).The clearance of Scrin group( post-dilution, 23.18±1.59) andgroups(mixed-dilution, 1:1group1.79±5.41,1:4group23.86±2.31,2:3group23.86±3.82,1:2group24.08±2.17,2:1group23.87±2.71,3:2group23.50±2.75,4:1group23.13±2.57)is superior togroup( pre- dilution, 18.78±4.17); There was no difference between the group(post-dilution) and groups( mixed-dilution)(P>0.05); every group( mixed-dilutions) was not statisticaldifference(P>0.05). The clearance of ?2-MGin group(post-dilution, 24.23±3.40) and groups( mixed-dilutions, 1:1group26.13±8.46,1:4group24.14±3.26 2:3group25.82±3.12,1:2group25.11±3.14,2:1group23.59±2.60,3:2group23.63±3.67,4:1group23.28±3.12)were superior togroup( pre- dilution, 19.19±3.95)(P<0.05). Therewas no difference between the group(Post-dilution) and groups(mixed-dilutions)(P>0.05); every group( mixed-dilution) is not statistical difference(P>0.05).Conclusions 1. For forty minutesafter hemodiafiltration, the clearance of small molecule toxins, such as Scr and BUN, in group( post-dilution) isbetter than other groups, The clearance ofbig and middle molecule toxins, such as ?2-MG did not show the difference during the dilution modes and ratios.2. For four hours after hemodiafiltration, the clearance of small and middle solutes in group( post-dilution) and groups(mixed-dilutions) was superior to group(pre- dilution), thereby, there was no diffirence betwween the group( Post-dilution) and groups(mixed-dilutions). Every group of mixed-di lution is not different.