| Chronic renal failure is a chronic disease that can progress gradually, it will cause a series of metabolic disorders and clinical syndromes. The toxin in the body of patients with chronic renal failure can be divided into three groups by the molecular weight: large, middle and small molecular toxin. Different blood purification, such as hemodialysis (HD), hemodiafiltration (HDF) or hemoperfusion+hemodialysis (HP+HD), has different clearance effect on toxin of different molecular weight. It makes great sense for the treatment and prognosis of chronic renal disease to research how to find out the appropriate blood purification way reasonably.Objective: To research the different clearance effect among HD, HDF and HP+ HD on middle and small molecular toxin by comparing the clearance effect of different blood purification methods on creatinine, blood urea nitrogen, phosphorus, parathyroid hormone and dialysis adequacy, so that we can choose the appropriate blood purification way reasonably to heal the patients with chronic renal failure.Methods: Thirty-three patients (aged 25 to 73 years, 20 men and 16 women) were recruited from the blood purification centre of the First Hospital of Jilin University. All the patients got three times blood purification weekly, and four hours for every time. Patients in the HP+HD group got hemoperfusion for two hours at the beginning, then hemodialysis for another 2 hours. All the patients were divided into three groups randomly with different blood purification. The HD group had 12 patients including 7 men and 5 women, aged 44.6±2.9 years, who had been treated for 29±2 months. The HDF group had 12 patients, including 7 men and 5 women, aged 45.6±3.3 years, who had been treated for 31±2 months. The HP+HD group had 12 patients, including 6 men and 6 women, aged 46.8±3.2 years, who had been treated for 30±3 months. The blood specimens were get from artery before and after blood purification. Creatinine, blood urea nitrogen, phosphorus and PTH were measured in the laboratory of the First Hospital of Jilin University. The clearance rate of toxin and dialysis adequacy (Kt/V) were calculated by formula. Data were processed by SPSS10.0 statistics software package. Measurement data were shown by ( x±s), the comparison between two groups is t- test. Count data was processed byχ2-test. The test standard was bilateralα=0.05.Results: 1. Comparison between before and after treatment in each group: (1) The concentration of creatinine, blood urea nitrogen and phosphorus decreased greatly after blood purification in each group, P<0.05, which had the statistical significance. (2) The concentration of PTH was compared between before and after treatment in HD group, P>0.05, which didn't have the statistical significance; The concentration of PTH decreased greatly after treatment in HDF group and HP+HD group, P<0.05, which had the statistical significance. 2. Comparison of toxin clearance rate among three groups: (1) The clearance rate of creatinine, blood urea nitrogen and phosphorus among three groups had no great difference, P>0.05, which didn't have the statistical significance. (2) Comparing the clearance rate of PTH between HD and HDF group, P<0.05, which had the statistical significance; compareing the clearance rate of PTH between HD group and HP+HD group, P<0.05, which had the statistical significance; Comparing the clearance rate of PTH between HDF group and HP+HD group, P>0.05, which didn't have the statistical significance. 3. Comparison of Kt/V among groups: Comparing HD group with HDF group,P>0.05, which didn't have the statistical significance; Comparing HD group with HP+HD group, P>0.05, which didn't have the statistical significance; Comparing HDF group with HP+HD group, P>0.05, which didn't have the statistical significance.Conclusions: (1) HD, HDF and HP+HD can clear small molecular toxin (creatinine, blood urea nitrogen and phosphorus) effectively,and the clearance rate of small molecular toxin among three groups didn't have the statistical significance. (2) HD can't clear PTH effectively; HDF and HP+HD can clear PTH effectively; comparing the clearance rate of HDF and HD+HP on PTH with HD have the statistical significance, but comparison of the clearance rate on PTH between HDF and HP+HD didn't have statistical significance. (3) The comparison of dialysis adequacy (Kt/V) among three different blood purification ways didn't have statistical significance. In a word, HD can only clear small molecular toxin effectively. HDF and HP+HD can clear small and middle molecular toxin effectively too. The clearance effect between the last two ways didn't have statistical significance.Larger sample Evidence-Based Medicine research is required to evaluate long-term efficacy...
|
PDF Full Text Request