Effects Of Different Dialyzer On Renal Relative Factors About Osteodystrophy In Patients With Maintaining Hemodialysis

Objective: (1)To study the relative factors about renal osteodystrophy (ROD)and the effects of hemodialysis on it by observing the effects of different dialyzer membranes on different solute clearance in patients with maintaining hemodialysis(MHD), especially on serum phosphorus and intact parathyroid hormone(PTH) levels.(2)To observe the effect of different dialyzer and the dialyzer reused (used 5 times )on the clearance of urea, creatinine, serum phosphorus and iPTH.Mathods: We studied a total 30 patients (12 women and 18 men) with maintaining hemodalysis, who were diagnosed ROD with high levels of phosphorus and iPTH, and divided into three groups randomly. Three kinds of dialyzers which were used on each group patients were: cellulose acetate (1.3m2 CA), hemophan (1.4m2 HE) and polysulfone (1.3m2 PS).Blood flow rate was 200~300ml/min and dialysate flow rate was 500 ml/min. Hemodialysis was performed two times weekly for a period of 270 minutes each. The levels of serum iPTH, phosphorus, calcium(Ca), blood urea nitrogen(BUN) and creatinine(Cr) were measured on pre-hemodialysis and post-hemodialysis. The descending rate of urea, creatinine,phosphorus, iPTH and the change of Ca level of each dialyzer were also measured by using new and reused dialyzers. The values KT/V were calculated by measuring the levels of BUN on pre-dialysis and post-dialysis.Result: (l)The levels of serum phosphorus and iPTH in patients with MHD were significantly increased than control group(P<0.01), but had no obvious difference in studied groups (CA group, HE group and PS group). After hemodialysis, levels of serum phosphorus and iPTH were decreased significantly that compared before hemodialysis (P<0.01). The serum Ca was obviously increased(P<0.05) after hemodialysis compared before hemodialysis .(2)The level of serum phosphorus was no significant difference after hemodialysis with HE membrane compared with the control group. The descending rates of serum iPTH in PS and HE groups were significantly higher than CA group(P<0.05), there were no significantly difference between PS and HE groups(PS group and HE group>CA group). (3)The values of KT/V were not significantly different among CA group, HE group and PS group. Compared with the first used dialyzer, The values of KT/V significantly decreased on reused dialysis(CA group>PS and HE groups, P<0.05).There were no significantly difference in the descending rate of iPTH with first used dialyzers on compared reused HE and PS groups, but descending rate of iPTH with reused CA group was significantly decreased compared that PS and HE groups. Conclusion: (l)Different kinds of hemodialysis membranes have different effects on serum phosphorus and iPTH. Among PS membrane , HE membrane and CA membrane, the clearance rate of serum phosphorus is the highest with the HE membrane among three hemodialysis membranes.(2) The clearance rate of serum iPTH in CA membrane is the lowest among three membranes. The reasons are :l)The ability of ahesion to protein and hydrophilia of dialyzer is negative relative. The hydrophilia of CA dialyzer is the highest, so it's ability of ahesion to protein is the lowest. 2) The function of hepatic and kidney is increased in analyzing toxin because of increased clearance of toxin by hemodialysis.(3) When the dialyzers were reused 5 times, not the clearance rate of urea, creatinine and serum phosphorus but the values of KT/V were significantly decreased. The clearance rate of iPTH is not obviously changed when PS and HE dialyzers are reused.