| Objective To investigate the clearance effect of parathyroid hormone(PTH)levels and safety by using high cut-off hemodialysis(HCO-HD)in maintenance hemodialysis patients which may provide a clue for the selection of dialysis mode for long-term maintenance hemodialysis patients.Methods According to the selection criteria,10 patients with stable maintenance hemodialysis were recruited from the period of August 2018 to January 2019 in the hemodialysis center of Jiangsu Subei People's Hospital.Except for 4 patients who were short of hemodiafiltration machine in our hospital,they only received single ordinary hemodialysis and high cut-off hemodialysis,and all the other patients were given single hemodialysis,hemodiafiltration and high cut-off hemodialysis for 4 hours per time.More than one ordinary hemodialysis was given between the three dialysis modes to avoid interference factors.During the dialysis process,the weight and ultrafiltration volume of patients before and after dialysis were recorded,and the vital signs and any adverse reactions related to dialysis during and after dialysis were monitored.Blood samples were collected before and after dialysis.Albumin,urea nitrogen,creatinine,calcium,phosphorus and parathyroid hormone before and after dialysis were measured.At the same time,the common data and biochemical indicators of the three groups were compared between and within groups.All data analysis was performed by SPSS 20.0 software package,with P<0.05 as statistically significant.Results 1)A total of 5 males and 5 females were enrolled in the study,The average age was(50.89±15.33)years(31-79years),the average BMI was(19.34±2.99)Kg/m2,and the average dialysis time was(76.0±26.15)months(48-108 months).Among them,8 patients with primary disease were glomerular disease,1 patients was hypertensive nephropathy,and 1 patient was type 2 diabetic nephropathy.2)The vital signs such as blood pressure and heart rate were stable in all patients during and after dialysis.Among patients given HCO-HD,one patient had transient skin itching during dialysis,two patients had dizziness,fatigue and hunger after dialysis,and the symptoms eased after 1 day of continuous follow-up.O ne patient felt that lower limb pain realieved after dialysis.The rest of the patients did not suffer from skin itching,dizziness,fatigue,hunger,fever and other uncomfortable symptoms.3)After treatment,urea nitrogen and serum creatinine in the three groups were significantly lower than before(P<0.05).There was no significant difference in blood calcium and phosphorus before and after dialysis(P>0.05).There was no significant difference in serum albumin in HD group after treatment.In HDF group,serum albumin decreased by 3.61g/L per dialysis(P <0.05),and in HCO-HD group,serum albumin decreased by 7.27g/L per dialysis(P <0.05).Compared with HD group,the difference of albumin changes between HDF group and HCO-HD group after treatment was greater than that of HD group,and the difference of albumin changes of HCO-HD group was greater than that of HDF group,with significant difference(P >0.05).4)In this study,HD,HDF and HCO-HD could reduce PTH,and there were significant differences between the three groups before and after treatment(P <0.05).The average PTH clearance rate of HD group was 14.74%,HDF group was 52.74%,and HCO-HD group was 62.34%.Compared with HD group,PTH clearance rate of HDF group and HCO-HD group was higher than that of HD group(P <0.05).There was no significant difference in PTH c learance between HCO-HD group and HDF group(P >0.05).5)The average KT/V was 1.34 and URR was 66.7% in HD group,1.38 and 69.6% in HDF group,1.35 and 67.20% in HCO-HD group.There was no significant difference in KT/V and URR between the thee groups(P >0.05).Conclusion 1)This study preliminarily confirmed that high cut-off hemodialysis(HCO-HD)can significantly remove parathyroid hormones in maintenance hemodialysis patients.2)High cut-off hemodialysis(HCO-HD)is safe,but it may be associated with risks such as albumin losses. |
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