Comparing The Fect Of High-Flux Hemodialysis, Convention Hemodialysis And Hemodiafiltration

Background:With pervasion and development of blood purification techniq, the life span of uraemia patients has been prolonged. Simultaneously, some long-term complication also occurred, such as renal osteodystrophy, dialysis-related amlioddosis,and cardiovascular disease which have been considered by medical workers. Middle molecule substance (MMS) (molecule weight 300-15,000 Dalton) was original substance of uraemia toxicosis^[1] . The present view was that most long-term complications were mainly associated with the clearing insufficiency of middle molecule toxins. It was also accepted that convention low-flux hemodialysis cleared small molecule substance such as urea, creatinine,ect, but not clear middle molecule toxins such as β₂-microglobulin (β₂-MG)^[2]. Howere, MMS could be eliminated by peritoneal dialysis (PD). The defect being hard to peritoneal dialysis overcome is that not only clear uraemia toxins, but also loss a great quantity proteins and be easy to be infected and to be lead to inflammation. Hemoperfusion also have some clearing effect to middle molecule substance. Because the composition of uraemia middle molecule toxins is complex. The knowledge about which is not enough, which limited us to manufacture the high-selective adsorbing. Hemodiafiltration (HDF) can clear middle molecular substance, because it needs special equipment and a great quantity of displacement liquid, which limit the spreading of HDF. HFHD is using high-flux dialyzer in capacity-controlling ordinary Hemodialysis machine to practicemaintenance hemodialysis, which does not need special equipment, therefore it is gradually being generalized in primary hospital.With the general application of High-flux hemodialysis in clinic, people have been worrying about which not only eliminate middle molecular toxins but also result in malnutrition. This group data aimed to comparing the effect of high-flux hemodialysis to convention hemodialysis and hemodiafiltration on clearing of uremic toxins and changing of nutrient substance.Methods:38 maintaining hemodialysis .patients were randomly divided into convention hemodialysis group (CHD group) (n=14), high-flux hemodialysis groups (HFHD groups)(n=14) and hemodiafiltration group (HDF group)(n=10). CHD group and HFHD group was carried out 2 times treatment every week respectively and 4.5 hours per treatment. HDF group was carried out 3 times HD treatment every 2 weeks and 4.5 hours per treatment and 1 time HDF treatment every 2 weeks and 4.0 hours per treatment. Their plasma levels of Urea, Na+, Cl", K+, Ca2+,K, P, CO2-CP, 02 -microglobulin( j82-MG) and plasma albumin were detected before and just before the end of treatment. The data of three groups were compared each other.Results:1. The clearance rates of j32-MG in HFHD group and in HDF group are higher than that in CHD group. (P<0.05)2. The clearance rates of iS2—MG in HDF group were significantly higher than those in HFHD groups (PO.05)3.There were no significant of Urea, Cr and albumin between three groups. 4. There were no significant differences about the improvement of Na+ -. Cl\ K+> Ca2\ P> CO2-CP among three groups.Conclusions:1. But the clearance rates of median molecular solutes in HFHD group and HDF group are superior to those in CHD group.2. The clearance effect of HDF group is superior to those in HFHD group.3. The clearance rates of small molecular solutes and the rectification acid-base balance and electrolyte disturbances are similar to each other in three groups. The elimination of ALB in HFHD group and HDF group are no more than that in CHD.