The influence of various blood purification methods on intradialytic hypotension in maintenance dialysis

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1 MHD IDH 30 HD HDF HP + HD β 2 - β 2 -MG N B NT-proBNP ALB 1HDF + HD HP + HD P < HDF β 2 -MG P < HP + HD HDF β 2 -MG P < HP + HD P < HD NT-proBNP HDF HP + HD NTproBNP P < ALB 3 ALB P > HDF HP + HD MHD IDH DOI /j. issn The influence of various blood purification methods on intradialytic hypotension in maintenance dialysis patients LI Zhuanhuan DONG Jiecheng LI Xia ZHANG Keng Chancheng Central Hospital Foshan China Abstract Objective To explore the efficacy of different blood purification methods on intradialytic hypotension IDH in maintenance hemodialysis MHD patients. Methods Thirty MHD patients with IDH were randomly divided into three groups hemodialysis HD group n = 10 hemodiafiltration HDF group n = 10 hemoperfusion combined with hemodialysis HP + HD group n = 10. The changes of blood pressure in therapy and the frequency of intradialytic hypotension were compared. Before and after the first treatment after 24 weeks of treatment serum blood beta 2-microglobulin β 2 -MG serum NT-proBNP albumin ALB were measured. Results 1Compared with HD group the frequency of intradialytic hypotension was significantly reduced in HDF and HP + HD group P < In HFD group serumβ 2 - MG decreased after the first dialysis session P < After the treatment for 24 weeks serumβ 2 -MG levels decreased in HP + HD and HFD group P < especially in HP + HD group P < Serum NT-proBNP cannot decreased after first dialysis session and after the treatment for 24 weeks in HD group however can decreased in HFD and HP + HD group P < There were no changes of ALB levels between three groups after first dialysis session and after the treatment for 24 weeks P > Conclusion Hemodiafiltration or hemoperfusion associated with hemodilysis can improve the hemodynamic stability in IDH patients it can be used as a long term therapy. Key words Hemodiafiltration Hemoperfusion Intradialytic hypotension IDH MHD probnp β 2 -MG ALB MHD 20% ~ 30% 1 IDH 4 IDH MHD IDH 2-3 IDH IDH IDH IDH IDH NT

2 / ml / kg h 3 P > IDH 30 1HD 3 / 4 h / TS-1. 3S kpa m ~ 300 ml /min 2HDF + HD < kpa < 4. 0 kpa 1 HDF 2 HD 4 h / HDF 1 3 TS-1. 3U 1. 3 m 2 50% 200 ~ 300 ml /min HD HDF + HD HP + HD 10 HD HA230 2 h ± ± ~ 300 ml /min HD HD HDF + HD ± ± HP + HD ± ± Ⅲ-Ⅳ NYHA NT-proB- NP PTH hs-crp β 2 -MG NT- probnp ALB 1. 2 x 珋 ± s SPSS TR-8000YUGA t TR-8000YUGA Na mmol /L K + 2 mmol /L = 1000 HD HD 3HP + HD 3 1 HD + HP 2 HD 2 h HD min 1 h LSD Ca mmol /L Mg mmol /L HCO ~ χ 2 P < mmol /L Gluc 0 mmol /L ml /min 4 h IDH HD %

3 β 2 -MG NT-proBNP 38. 3% 72 10% HDF + HD % % MG P < HD HP + HD β % HP + HD MG 24 HP + HD HDF % β 2 -MG P < HP + HD % HD P < % HDF + HD HP + HD IDH HD P < IDH IDH IDH IDH /% HD HDF + HD ALB HDF β 2-24 HD NT-proBNP HDF HP + HD NT-proBNP P < HD P < ALB 3 ALB P > HP + HD IDH IDH 2 24 β 2 -MG NT-proBNP ALB x 珔 ± s β 2 -MG / mg L -1 NT-proBNP / pg ml -1 ALB / g L HD ± ± ± ± ± ± ± ± ± HDF ± ± ± ± ± ± ± ± ± HD + HP ± ± ± ± ± ± ± ± ± P < HD P < β 2 -MG MHD β 2 -MG IDH 15 IDH IDH β 2 -MG IDH NT-proBNP HDF MHD β 2 -MG ALB IDH β IDH 4 2 -MG HD HP + HD β 2 -MG NTproBNP HDF 2 -MG β HP HDF HP 24 HP + HD HDF β 2 - HD β 2 -MG MG HP + HD HDF HD 17 HP + HD IDH β 2 -MG HP HDF HD + HP β 2 -MG HD P < IDH NT-proBNP 8. 5 KD IDH IDH NT-proBNP β 2 -MG BNP NT-proBNP

4 NT-proBNP J. Am Soc Nephrol IDH 2 ISEKI K MIYASATO F TOKUYAMA K et al. Low 18 HD diastolicblood pressure hypoalbuminemia and risk of MHD NT-proBNP 24 HD IDH Kidney Int HD 3 SHOJI T TSUBAKILMM Y FUJII M et al. Hemedialysis ssociated hypotension as an independent risk factor HDF HP + HD 24 NT-proBNP P < NT-proBNP P > HDF HP + HD NT-proBNP IDH 5 SONG J H PARK G H LEE S Y et al. Effect of sodi- HDF HP um balanceand the combination of ultrafiltration profile during sodium profi ling hemodialysis on the maintenance HDF HP + HD of the quality of dialysis and sodium and fluid balances NT-proBNP J. J Am Soc Nephrol HDF HP + HD 6 ZHOU Y L LIU H L DUAN X F et al. Impact of sodium and ultrafiltration profiling on haemodialysis-related NT-proBNP MHD hypotension J. Nephrol Dial Transplant IDH HDF HP 7. HDF HP J ALB J. 3 ALB HDF HP + HD ALB 17 J HDF HP 10. J. 2HDF HP C J. HDF HP + HD HD MHD β 2 -MG NT-proBNP 12. ALB IDH MHD J KURAGANO T KIDA FURUTA M et al. The impact of beta2-microglobulin clearance on the risk factors of cardiovascular disease in hemodialysis patients J. ASAIO J PALMER B F HENRICH W L. Recent advances in the prevention and management of intradialytic hypotension death in a cohort of chronic hemodialysis patients J. for two ear mortality in hemodialysis patients J. Kidney Int J XIE J YI Q. Beta2-microglobulin as a potential initiator of inflammatory responses J. Trends Immunol SAIJO Y UTSUGI M YOSHIOKA E et al. Relationship of beta2-microglobulin to arterial stiffness in Japanese subjects J. Hypertens Res

5 predilutional and postdilutional hemofiltration J. Kidney Int β2- J KONO K TODA S HORA K et al. Direct hemoperfusion with a beta2-microglobulin-selective adsorbent col umn eliminates inflammatory cytokines and improves pulmonary oxygenation J. Ther Apher Dial J N- 21 J. J PADRINI R CANOVA C CONZ P et al. Convective and adsorptive removal of beta 2 microglobulin during J J GLP-1 9. J. D GLP-1 GK 135. J J J

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