Effects Of Different Dialysis Modes On Uremic Toxins And Nutritional Status

Objective To discuss the effects of two different dialysis modes,low-flux hemodialysis and high-flux hemodialysis,on the uremic toxin and nutritional status of maintenance hemodialysis patients,and to provide scientific basis for patients to choose appropriate blood purification methods in and delay the occurrence and development of uremia-related complications.Methods From January 2015 to December 2016,50 patients with maintenance hemodialysis were selected for regular dialysis at the Blood Purification Center of Tongliao Hospital,Inner Mongolia.Criteria for selected cases:(1)Patients diagnosed as chronic renal failure-uremia and who have been treated with maintenance hemodialysis.(2)Patients with stable condition who have been dialyzed with low-flux dialyzer FX10 for more than 3months.(3)Patients aged 20-90 years with unlimited sex.(4)Patients with dialysis with Fesenius 4008 S dialyzer and long-term blood established with arteriovenous fistula.Low molecular weight heparin was used as anticoagulant in dialysis pathway.The dialysate was bicarbonate dialysis.The dialysate flow rate was 500 ml/min.The dialysate flow rate was controlled at 220-260 ml/min.Maintenance hemodialysis was performed three times a week for 4 hours each time.Exclusion criteria:(1)Other factors causing malnutrition such as trauma,tumors,digestive tract diseases,infectious diseases and active immune diseases in the near future.(2)Severe complications such as acute left heart failure,severe water and sodium retention,acute infection in the near future.(3)Patients with severe heart,lung,brain diseases and sequelae and metal stents or pacemakers in the body.The patients were randomly divided into two groups: low flux hemodialysis(LFHD)group and high flux hemodialysis(HFHD)group.Among them,25 cases in LFHD Group continued to use low-flux dialyzer FX10(its ultrafiltration coefficient is 14ml/(h·mmHg)with an areaof 1.8 square meters).And 25 cases in HFHD group changed to high-flux dialyzer FX80(its ultrafiltration coefficient is 59ml/(h·mmHg)with an area of 1.8 square meters),and dialyzed patients respectively for 6 months as observation period.The biochemical indexes and body composition indexes of the two groups were measured after first dialysis and 6 months after treatment(before dialysis).Biochemical indicators included creatinine,urea nitrogen,beta 2 microglobulin,parathyroid hormone,hemoglobin,serum albumin,triglyceride and total cholesterol before dialysis.Body composition was measured by human component analyzer.Body mass index(BMI),muscle tissue index(LTI)and adipose tissue index(FTI)were the indicators of body composition.Results(1)There was no significant difference in general condition between LFHD group and HFHD group before admission,and there was no significant difference in indexes of first dialysis after admission(P>0.05).(2)There was no significant difference in creatinine,urea nitrogen,beta 2microglobulin and parathyroid hormone after 6 months of treatment in LFHD group(P>0.05),and no significant difference in hemoglobin,serum albumin,triglyceride and total cholesterol(P>0.05).There was no significant difference in the BMI,LTI and FTI after 6 months of treatment in LFHD group(P>0.05).(3)There was no significant difference in creatinine and urea nitrogen after 6 months of treatment in HFHD group(P>0.05).The decrease of beta 2 microglobulin and parathyroid hormone had statistical significance after 6 months of treatment in HFHD group(P<0.05).There was statistical significance in the increase of hemoglobin and serum albumin(P<0.05).There was no significant difference in triglyceride,total cholesterol,BMI and FTI(P>0.05),but the increase of LTI is obvious and has statistical significance(P<0.05).(4)After 6 months of treatment,there was no significant difference in creatinine and urea between LFHD group and HFHD group(P>0.05).And no significant difference in triglyceride,total cholesterol,BMI and FTI between LFHD group and HFHD group(P>0.05).The decrease of beta 2 microglobulin and parathyroid hormone in HFHD group was significant,with statistical significance(P<0.05).And the increase of hemoglobin,serum albumin and LTI in HFHD group was significant,with statistical significance.(P<0.05).Conclusion High-flux dialysis issuperior to low-flux dialysis in the removal of macromolecular toxins such as beta-2microglobulin and parathyroid hormone,as well as in the improvement of hemoglobin,albumin and muscle tissue index.It can better remove uremic toxins and improve the nutritional status of patients,thus reducing the occurrence and development of complications.Considering the clinical application and economic situation,LFHD is preferred for patients with mild anemia,good nutritional status,low levels of medium and macromolecular toxins,and HFHD is preferred for patients with moderate to severe anemia,malnutrition and high levels of medium and macromolecular toxins.Medical staff can adjust different dialysis modes at any time according to the changes of patients' condition.