Randomized Control Study on Hemoperfusion Combined with Hemodialysis versus Standard Hemodialysis: Effects on Middle-Molecular-Weight Toxins and Uremic Pruritus

被引：9

作者：

Zhao, Delong ^{[1
]}

Wang, Yuanda ^{[1
]}

Wang, Yong ^{[1
]}

Jiang, Aili ^{[2
]}

Cao, Ning ^{[3
]}

He, Yani ^{[4
]}

Wang, Junxia ^{[5
]}

Guo, Zhiyong ^{[6
]}

Liu, Wenhu ^{[7
]}

Shi, Wei ^{[8
,15
]}

Hao, Lirong ^{[9
]}

Li, Jinyu ^{[10
]}

Li, Wenge ^{[11
]}

Wang, Caili ^{[12
]}

Wang, Jianqin ^{[13
]}

Lin, Hongli ^{[14
]}

Wang, Lihua ^{[16
]}

Jiang, Hongli ^{[17
]}

Ding, Guohua ^{[18
]}

Li, Yun ^{[19
]}

Hu, Wenbo ^{[20
]}

Yue, Hua ^{[21
]}

Liu, Jian ^{[22
]}

Yang, Xiaoping ^{[23
]}

Yang, Yibin ^{[24
]}

Liu, Guohui ^{[25
]}

Li, Hong ^{[26
]}

Xiao, Yuefei ^{[27
]}

Wang, Niansong ^{[28
]}

Jiang, Gengru ^{[29
]}

Ma, Guoying ^{[30
]}

Wang, Jie ^{[31
]}

Li, Ying ^{[32
]}

Li, Rongshan ^{[33
]}

Li, Qian ^{[34
]}

Sun, Shiren ^{[35
]}

Jiao, Jundong ^{[36
]}

Xi, Chunsheng ^{[37
]}

Cai, Guangyan ^{[1
]}

Sun, Xuefeng ^{[1
]}

Chen, Xiangmei ^{[1
]}

机构：

[1] Chinese Peoples Liberat Army Gen Hosp, Natl Clin Res Ctr Kidney Dis, Chinese PLA Inst Nephrol, Dept Nephrol,State Key Lab Kidney Dis, Beijing, Peoples R China

[2] Tianjin Med Univ, Hosp 2, Blood Purificat Ctr, Tiangjing, Peoples R China

[3] Northern Theater Gen Hosp, Blood Purificat Ctr, Shenyang, Peoples R China

[4] Army Med Univ, Daping Hosp, Dept Nephrol, Chongqing, Peoples R China

[5] Henan Univ Sci & Technol, Affiliated Hosp 1, Blood Purificat Ctr, Luoyang, Henan, Peoples R China

[6] Naval Med Univ, Dept Nephrol, Changhai Hosp, Shanghai, Peoples R China

[7] Beijing Friendship Hosp, Dept Nephrol, Beijing, Peoples R China

[8] Guangdong Prov Peoples Hosp, Dept Nephrol, Guangzhou, Peoples R China

[9] Harbin Med Univ, Affiliated Hosp 1, Dept Nephrol, Harbin, Peoples R China

[10] Heilongjiang Prov Peoples Hosp, Dept Nephrol, Harbin, Peoples R China

[11] China Japan Friendship Hosp, Dept Nephrol, Beijing, Peoples R China

[12] Baotou Med Coll, Affiliated Hosp 1, Dept Nephrol, Baotou, Peoples R China

[13] Lanzhou Univ, Affiliated Hosp 2, Dept Nephrol, Lanzhou, Peoples R China

[14] Dalian Med Univ, Affiliated Hosp 1, Dept Nephrol, Dalian, Peoples R China

[15] Guangxi Univ Tradit Chinese Med, Affiliated Hosp 1, Dept Nephrol, Nanning, Peoples R China

[16] Shanxi Med Univ, Affiliated Hosp 2, Dept Nephrol, Taiyuan, Peoples R China

[17] Xi An Jiao Tong Univ, Affiliated Hosp 1, Dept Nephrol, Xian, Peoples R China

[18] Wuhan Univ, Peoples Hosp, Dept Nephrol, Wuhan, Peoples R China

[19] Jiangxi Prov Peoples Hosp, Dept Nephrol, Nanchang, Peoples R China

[20] Qinghai Prov Peoples Hosp, Dept Nephrol, Xining, Peoples R China

[21] Xinjiang Uygur Autonomous Reg Peoples Hosp, Dept Nephrol, Urumqi, Peoples R China

[22] Xinjiang Med Univ, Affiliated Hosp 1, Dept Nephrol, Urumqi, Peoples R China

[23] Xinjiang Shihezi Univ, Affiliated Hosp 1, Dept Nephrol, Shihezi, Xinjiang, Peoples R China

[24] Guizhou Zunyi Med Coll, Affiliated Hosp, Dept Nephrol, Zunyi, Guizhou, Peoples R China

[25] Dongguan Peoples Hosp, Dept Nephrol, Dongguan, Peoples R China

[26] Hainan Peoples Hosp, Blood Purificat Ctr, Haikou, Hainan, Peoples R China

[27] Aerosp Ctr Hosp, Dept Nephrol, Beijing, Peoples R China

[28] Shanghai Sixth Peoples Hosp, Dept Nephrol, Shanghai, Peoples R China

[29] Shanghai Jiao Tong Univ, Dept Nephrol, Xinhua Hosp, Shanghai, Peoples R China

[30] Qiandongnan Peoples Hosp, Dept Nephrol, Kaili, Guizhou, Peoples R China

[31] Youjiang Ethn Med Coll, Affiliated Hosp, Dept Nephrol, Baise, Guangxi, Peoples R China

[32] Hebei Med Univ, Hosp 3, Dept Nephrol, Shijiazhuang, Peoples R China

[33] Shanxi Prov Peoples Hosp, Dept Nephrol, Taiyuan, Peoples R China

[34] Changsha Cent Hosp, Dept Nephrol, Changsha, Peoples R China

[35] Air Force Med Univ, Xijing Hosp, Dept Nephrol, Xian, Peoples R China

[36] Harbin Med Univ, Affiliated Hosp 2, Dept Nephrol, Harbin, Peoples R China

[37] Joint Logist Support Unit 940 Hosp, Dept Nephrol, Lanzhou, Gansu, Peoples R China

来源：

BLOOD PURIFICATION | 2022年 / 51卷 / 10期

基金：

中国国家自然科学基金;

关键词：

Hemoperfusion; Hemodialysis; Uremic toxins; Uremic pruritus; Adsorption; SERUM BETA(2)-MICROGLOBULIN LEVEL; SET-POINT; MAINTENANCE HEMODIALYSIS; PARATHYROID-HORMONE; DIALYSIS; FLUX; MORTALITY; COMBINATION; AMYLOIDOSIS; CALCIUM;

D O I：

10.1159/000525225

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Introduction: Classic hemodialysis schedules present inadequate middle-molecular-weight toxin clearance due to limitations of membrane-based separation processes. Accumulation of uremic retention solutes may result in specific symptoms (e.g., pruritus) and may affect clinical outcome and patient's quality of life. Hemoperfusion (HP) is a blood purification modality based on adsorption that can overcome such limitations, and thus, it may be interesting to test the efficacy of at least one session per week of HP combined with hemodialysis. This is a randomized, open-label trial, controlled, multicenter clinical study to investigate the effect of longterm HP combined with hemodialysis on middle-molecularweight toxins and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods: 438 MHD patients from 37 HD centers in China with end-stage kidney disease (63.9% males, mean age 51 years) suffering from chronic intractable pruritus were enrolled in the study. Eligible patients were randomized into four groups: low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), HP + LFHD, and HP + HFHD at a 1:1:1:1 ratio. Beta-2 microglobulin ((32M) and parathyroid hormone (PTH) were measured at baseline, 3-6, and 12 months. At the same time points, the pruritus score was evaluated. The primary outcome was the reduction of B2M and PTH, while the secondary outcome was the reduction of the pruritus score. Results: In the two groups HP + LFHD and HP + HFHD, there was a significant decrease of (32M and PTH levels after 12 months compared to the control groups. No significant differences were noted between HP + LFHD and HP + HFHD. Pruritus score reduction was 63% in the HP + LFHD group and 51% in the HP + HFHD group, respectively. Conclusion: The long-term HP + HD can reduce 112M and PTH levels and improve pruritus in MHD patients independently on the use of high- or low-flux dialyzers, showing that the results are linked to the effect of adsorption. (C) 2022 5. Karger AG, Basel

引用

页码：812 / 822

页数：11

共 39 条

[1] Attia Enas A S, 2014, Arab J Nephrol Transplant, V7, P91
[2] Barreto Fellype Carvalho, 2014, Braz. J. Nephrol., V36, P221, DOI 10.5935/0101-2800.20140033
[3] Combination of maintenance hemodialysis with hemoperfusion: A safe and effective model of artificial kidney
Chen, Shun-Jie
Jiang, Geng-Ru
Shan, Jian-Ping
Lu, Wei
Huang, Hai-Dong
Ji, Gang
Wu, Ping
Wu, Gu-Feng
Wang, Wei
Zhu, Chun
Bian, Fan
[J]. INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS, 2011, 34 (04) : 339 - 347
[4] Survival Outcomes of Hemoperfusion and Hemodialysis versus Hemodialysis in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis
Cheng, Wendi
Luo, Yashuang
Wang, Haiyin
Qin, Xiaoxiao
Liu, Xin
Fu, Yuyan
Ronco, Claudio
[J]. BLOOD PURIFICATION, 2022, 51 (03) : 213 - 225
[5] Association between serum β2-microglobulin level and infectious mortality in hemodialysis patients
Cheung, Alfred K.
Greene, Tom
Leypoldt, John K.
Yan, Guofen
Allon, Michael
Delmez, James
Levey, Andrew S.
Levin, Nathan W.
Rocco, Michael V.
Schulman, Gerald
Eknoyan, Garabed
[J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2008, 3 (01): : 69 - 77
[6] Chinese National Renal Data System, US
[7] Moving beyond small solute clearance: What evidence is there for more permeable dialyzers and haemodiafiltration?
Davenport, Andrew
[J]. HEMODIALYSIS INTERNATIONAL, 2018, 22 : S24 - S28
[8] High-Flux Dialysis: Clinical, Biochemical, and Proteomic Comparison with Low-Flux Dialysis and On-Line Hemodiafiltration
Donadio, Carlo
Kanaki, Angeliki
Sami, Nadia
Tognotti, Danika
[J]. BLOOD PURIFICATION, 2017, 44 (02) : 129 - 139
[9] Effect of dialysis dose and membrane flux in maintenance hemodialysis.
Eknoyan, G
Beck, GJ
Cheung, AK
Daugirdas, JT
Greene, T
Kusek, JW
Allon, M
Bailey, J
Delmez, JA
Depner, TA
Dwyer, JT
Levey, AS
Levin, NW
Milford, E
Ornt, DB
Rocco, MV
Schulman, G
Schwab, SJ
Teehan, BP
Toto, R
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (25) : 2010 - 2019
[10] High plasma pentosidine level is accompanied with cardiovascular events in hemodialysis patients
Furuya, Ryuichi
Kumagai, Hiromichi
Miyata, Toshio
Fukasawa, Hirotaka
Isobe, Shinsuke
Kinoshita, Naoko
Hishida, Akira
[J]. CLINICAL AND EXPERIMENTAL NEPHROLOGY, 2012, 16 (03) : 421 - 426

← 1 2 3 4 →