Effect of on-line hemodiafiltration with endogenous reinfusion (HFR) on the calcium-phosphorus metabolism: medium-term effects

被引:12
作者
Bolasco, P. G.
Ghezzi, P. M.
Ferrara, R.
Maxia, M.
Pinna, M.
Logias, F.
Cogoni, G.
Cadinu, F.
Ghisu, T.
Contu, B.
Casu, D.
Passaghe, M.
Pilloni, A.
Ganadu, M.
Gazzanelli, L.
机构
[1] Unita Operat Terr Nefrol & Dialisis, I-09045 Cagliari, Italy
[2] AO S Croce & Carle, Nephrol & Dialysis Div, Cuneo, Italy
[3] Osped SS Trinita, Nephrol & Dialysis Serv, Cagliari, Italy
[4] Casa Cura Polispecialist Sant Elena, Dialysis Serv, Quartu St Elena, Italy
[5] Osped SS Annunziata, Nephrol & Dialysis Div, Sassari, Italy
[6] Sorgono & Osped S Giuseppe, Osped S Camillo, Nephrol & Dialysis Div, Isili, Italy
[7] Osped San Martino Genova, Nephrol & Dialysis Serv, Oristano, Italy
[8] Osped S Francesco, Nephrol & Dialysis Serv, Nuoro, Italy
[9] Osped Civile, Nephrol & Dialysis Serv, Macomer, Italy
[10] Osped Civile, Nephrol & Dialysis Serv, Lanusei, Italy
[11] Osped Civile, Nephrol & Dialysis Serv, Alghero, Italy
[12] Osped Civile, Nephrol & Dialysis Serv, Tempio Pausania, Italy
[13] Osped NS Bonaria, Nephrol & Dialysis Serv, San Gavino Monreale, Italy
[14] Osped Segni, Nephrol & Dialysis Serv, Ozieri, Italy
[15] Osped Segni, Nephrol & Dialysis Serv, Ozieri, Italy
[16] Osped Merlo, Nephrol & Dialysis Serv, La Maddalena, Italy
关键词
HFR; on-line hemodiafiltration with endogenous reinfusion; bone metabolism; cytokines; dialysis microinflammation;
D O I
10.1177/039139880602901104
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Aim: The purpose of the study was to examine the effect of hemodiafiltration with endogenous reinfusion (HFR) compared to hemodialysis (HD) on 28 uremic patients with secondary hyperparathyroidism (2HPT) but positively selected for good and stable control of phosphatemia in order to evaluate the independent effects of dialysis treatments on bone turnover metabolism. Methods: The study was divided into 3 periods of observation: a) HD for three months; b) HFR for three months; c) HFR for a further 3 months. We analysed the trend of: whole PTH, 1-84 PTH, 7-84 PTH, alkaline phosphatase and its bone isoenzyme, total and ionised calcium, phosphatemia, dose of phosphate binder agents, beta 2-microglobulin, CRP. All the variations found were evaluated through mean values +/- SD, t-tests, multivariate analysis. Results: We observed a deceleration in bone turnover characterized by a reduction of the total and bone alkaline phosphatase (IU/mL) from 92.3 +/- 82.8 and 35.8 +/- 49.8 at the end of HD to 63.4 +/- 23.9 and 16.0 +/- 8.7 at the end of HFR, respectively, and 1-84 PTH from 317.5 +/- 264.6 pg/mL at the end of HD to 287.5 +/- 258.9 pg/mL at the end of the 3(rd) month of HFR. beta 2-microglobulin was reduced from 32.9 +/- 16.1 mg/L at the end of HD to 26.4 +/- 8.1 mg/L already at the end of the first three months of HFR. CRP was reduced from 2.5 +/- 2.6 mg/dL at the beginning of the study to 1.3 +/- 1.7 mg/dL at the end of HFR. There were no differences with regard to: dialytic efficiency, nutritional status, calcemia, phosphatemia (maintained in the K-DOQI range for the entire duration of the study), also thanks to more careful use of phosphate chelating agents. Conclusion: We are of the opinion that HFR-essentially thanks to the use of ultrapure endogenous infusate-induces a deceleration in bone turnover due to 2PHT. In addition, phosphate substraction in HFR is better compared to HD, thanks to the improvement of the anti-inflammatory conditions by removing the cytokines harmful to bone metabolism and excluding a priori the negative effects related to hyperphosphatemia.
引用
收藏
页码:1042 / 1052
页数:11
相关论文
共 33 条
[1]   The role of abnormal phosphorus metabolism in the progression of chronic kidney disease and metastatic calcification [J].
Alfrey, AC .
KIDNEY INTERNATIONAL, 2004, 66 :S13-S17
[2]  
Block G, 2002, SEMIN DIALYSIS, V15, P315, DOI 10.1046/j.1525-139X.2002.00077_1.x
[3]   Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: A national study [J].
Block, GA ;
Hulbert-Shearon, TE ;
Levin, NW ;
Port, FK .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1998, 31 (04) :607-617
[4]   New method for phosphate kinetics estimation during hemodialysis and on-line hemodiafiltration with endogenous reinfusion [J].
Bolasco, P ;
Ghezzi, PM ;
Ferrara, R ;
Cogoni, G ;
Cadinu, F ;
Casu, D ;
Murtas, S .
BLOOD PURIFICATION, 2006, 24 (03) :301-308
[5]   The effect of coupled haemofiltration and adsorption on inflammatory cytokines in an ex vivo model [J].
Cole, L ;
Bellomo, R ;
Davenport, P ;
Tipping, P ;
Uchino, S ;
Tetta, C ;
Ronco, C .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2002, 17 (11) :1950-1956
[6]  
Costantini S, 2004, G Ital Nefrol, V21 Suppl 30, pS75
[7]   Hemodiafiltration with online regeneration of the ultrafiltrate [J].
de Francisco, ALM ;
Ghezzi, PM ;
Brendolan, A ;
Fiorini, F ;
La Greca, G ;
Ronco, C ;
Arias, M ;
Gervasio, R ;
Tetta, C .
KIDNEY INTERNATIONAL, 2000, 58 :S66-S71
[8]   Hemodiafiltration with on-line endogenous reinfusion [J].
de Francisco, ALM ;
Piñera, C ;
Heras, M ;
Rodrigo, E ;
Fresnedo, GF ;
Ruiz, JC ;
Tetta, C ;
Arias, M .
BLOOD PURIFICATION, 2000, 18 (03) :231-236
[9]   Haemodiafiltration with sorbent-regenerated ultrafiltrate as replacement fluid: A multicenter study [J].
deFrancisco, ALM ;
Botella, J ;
Escallada, R ;
Hernandez, J ;
Malo, AM ;
Garcia, RP ;
Tomero, JAS ;
Sanz, C .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 1997, 12 (03) :528-534
[10]   HYPERPHOSPHATEMIA - ITS CONSEQUENCES AND TREATMENT IN PATIENTS WITH CHRONIC RENAL-DISEASE [J].
DELMEZ, JA ;
SLATOPOLSKY, E .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1992, 19 (04) :303-317