A Comparison Of The Advantages And Disadvantages Between Continuous Blood Purification And Intermittent Hemodialysis In Treating Patients With Uremic Encephalopathy

Background and Objectives:Uremic encephalopathy is an acute or subacute reversible neuropsychiatric symptom in patients with end-stage renal disease(ESRD),which seriously affects the survival and the quality of life of patients with chronic kidney disease.The pathogenesis of uremic encephalopathy is not entirely clear.It may be associated with such factors as uremic toxins,dysregulaton of endocrinologic and drugs,and some macromolecular substances and medium molecular substances such as PTH may play an important role in the onset of the disease.The clinical manifestations of uremic encephalopathy are diverse,including fatigue,weakness,and decline in understanding and memory and so on in the early stage,and with the progression of the disease,laziness to speak,indifferent reaction,disturbance of consciousness later appear.Severe patients may exhibit delirium,coma,asterixis,etc.The treatment methods of the disease include general treatment,etiological treatment and dialytic treatment.At present,the most commonly used treatment is the blood purification therapy.The aim of this survey is to observe and compare the advantages and disadvantages between continuous blood purification and intermittent hemodialysis in the treatment of uremic encephalopathy,and to provide the foundation for the reasonable treatment of uremic encephalopathy.Methods:A non-random retrospective analysis of 75 cases with uremic encephalopathy meeting the diagnostic criteria from January 2012 to December 2016 in the second hospital of Jilin University is made,other causes of neuropsychiatric diseases are excluded.Among them,50 patients were treated with continuous blood purification(CBP Group)and 25 patients underwent intermittent hemodialysis(IHD Group).All clinical data were collected from the patient records and dialysis records,including sexuality,onset age,primary disease,incentive,clinical manifestations,time required for symptom relief,hematological and serum biochemical test indicators,vital signs,and complications of treatment.To contrast the time and cost required for symptom relief as well as the changes in test indicators and vital signs before and after the treatment bewteen two groups.Results:1.There are no statistical differences in contrast of sexuality,onset age,composition of primary disease,incentives and clinical manifestations between the two groups(P>0.05).2.The cost and time spent by CBP group for dialysis are significantly higher than those of IHD group(P<0.05),and the time required for symptom improvement and recovery is significantly lower than that of IHD group(P<0.05).3.The levels of micromolecule urotoxins in both groups were significantly lower than the levels before the treatment(P<0.05).The decrease in IHD group is higher than that of CBP group(P<0.05).After treatment,the levels of medium molecular toxins in CBP group are significantly lower than those before the treatment(P<0.05).4.The levels of posttreatment serum phosphorus in the two groups are significantly lower than those before treatment(P<0.05).5.The levels of erythrocyte,hemoglobin,HCT and PCT of CBP group are significantly lower than those before treatment(P<0.05).6.The level of albumin in CBP group is significantly lower than that before treatment(P<0.05).7.The heart rate and blood pressure in both groups under treatment or posttreatment have no obvious variation compared with prior treatment(P>0.05).8.The proportion of patients with Intradialytic hypertension in CBP group is significantly higher than that in IHD group(P<0.05),while the proportion of patients with Intradialytic hypotension in IHD group is significantly higher than that in CBP group(P<0.05)Conclusions:1.The time required for recovery of CBP treatment is shorter than that of IHD treatment,but the cost of CBP treatment is higher than that of IHD treatment.2.Both CBP treatment and IHD treatment can reduce the levels of urotoxins,and the effect of CBP treatment is better than that of IHD treatment,but it may influence on its blutbuid and nutritive index.3.CBP treatment and IHD treatment have tiny influence on the vital signs of the patients in this analysis,but they have a difference in their complication.