Rachel Gatti Armani, Aluizio Barbosa Carvalho, Monique Vercia Rocha E Silva, Renata Verardino, Luiz Bortolotto, Maria Eugenia F Canziani
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This study aimed to compare the effect of dialysis with MCO or high-flux membranes on the endothelial function of patients on chronic HD.</p><p><strong>Methods: </strong>A prospective, randomized, crossover study in which 32 patients with ESKD were dialyzed for 12 weeks with each membrane, including a 4-week washout period between treatments. Endothelial function was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound at weeks 1, 12, 16, and 28.</p><p><strong>Results: </strong>The population consisted of 59% men, 52.7 ± 13.4 years, 16% non-black, on HD for 8.8 (4.1-15.1) years, and 72% with arteriovenous fistula. Hypertension was the most common etiology of chronic kidney disease, and 34% of patients had previous cardiovascular disease. Patients were grouped, regardless of treatment sequence, into MCO or high-flux groups, since no carryover (p = 0.634) or sequence (p = 0.998) effects were observed in the FMD assessment. The ANOVA model with repeated measures showed no effects of treatment (p = 0.426), time (p = 0.972), or interaction (p = 0.413) in the comparison of FMD between the MCO and high-flux groups.</p><p><strong>Conclusion: </strong>Dialysis performed with MCO, or high-flux membranes, had no influence on endothelial function in patients undergoing HD. 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引用次数: 0
摘要
背景:内皮功能障碍(ED)被认为是血管并发症的标志,尤其是在终末期肾病(ESKD)患者中。在接受血液透析(HD)的患者中,炎症和尿毒症状态会导致内皮功能障碍。最近,有人提出中截留(MCO)透析膜能有效清除炎症细胞因子和大中型尿毒症毒素,具有改善血管内皮功能的潜在作用。本研究旨在比较使用 MCO 或高通量膜透析对慢性 HD 患者血管内皮功能的影响:这是一项前瞻性、随机、交叉研究,32 位 ESKD 患者使用每种膜透析了 12 周,包括治疗之间 4 周的冲洗期。在第1、12、16和28周时,使用肱动脉超声通过血流介导的扩张(FMD)对内皮功能进行评估:研究对象中 59% 为男性,52.7±13.4 岁,16% 为非黑人,接受 HD 治疗 8.8(4.1-15.1)年,72% 有动静脉瘘。高血压是慢性肾脏病最常见的病因,34%的患者曾患有心血管疾病。由于在 FMD 评估中未观察到携带效应(p=0.634)或顺序效应(p=0.998),因此无论治疗顺序如何,均将患者分为 MCO 组和高通量组。重复测量的方差分析模型显示,在 MCO 组和高通量组的 FMD 比较中,治疗(p=0.426)、时间(p=0.972)或交互作用(p=0.413)均无影响:结论:使用 MCO 或高通量膜进行透析对接受 HD 的患者的内皮功能没有影响。结论:使用 MCO 膜或高通量膜进行透析对接受 HD 治疗的患者的内皮功能没有影响,但观察到使用 MCO 膜时 FMD 有增加的趋势。
Effect of Hemodialysis with Medium Cut-Off versus High-Flux Membranes on Endothelial Function of Patients with Chronic Kidney Disease.
Introduction: Endothelial dysfunction (ED) is considered a marker of vascular complications, especially in patients with end-stage kidney disease (ESKD). Inflammation and the uremic state contribute to ED in patients undergoing hemodialysis (HD). Recently, the medium cut-off (MCO) dialysis membrane has been proposed to efficiently remove inflammatory cytokines and large, middle-sized uremic toxins, with the potential effect to improve endothelial function. This study aimed to compare the effect of dialysis with MCO or high-flux membranes on the endothelial function of patients on chronic HD.
Methods: A prospective, randomized, crossover study in which 32 patients with ESKD were dialyzed for 12 weeks with each membrane, including a 4-week washout period between treatments. Endothelial function was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound at weeks 1, 12, 16, and 28.
Results: The population consisted of 59% men, 52.7 ± 13.4 years, 16% non-black, on HD for 8.8 (4.1-15.1) years, and 72% with arteriovenous fistula. Hypertension was the most common etiology of chronic kidney disease, and 34% of patients had previous cardiovascular disease. Patients were grouped, regardless of treatment sequence, into MCO or high-flux groups, since no carryover (p = 0.634) or sequence (p = 0.998) effects were observed in the FMD assessment. The ANOVA model with repeated measures showed no effects of treatment (p = 0.426), time (p = 0.972), or interaction (p = 0.413) in the comparison of FMD between the MCO and high-flux groups.
Conclusion: Dialysis performed with MCO, or high-flux membranes, had no influence on endothelial function in patients undergoing HD. However, a trend towards increased FMD was observed with the use of the MCO membrane.
期刊介绍:
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.