nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2022-26-1-57-68nefr-2081Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSЭффективность гемодиафильтрации on-line при хронической болезни почек: факторы риска и совершенствование оценки показателей выведения жидкостиThe effectiveness of on-line hemodiafiltration in patients with chronic kidney disease: risk factors and improving the assessment of fluid excretion valueshttps://orcid.org/0000-0002-3451-9674ЗаряЯ. В.ZaryaY. V.

Заря Яна Владимировна

194354, Санкт-Петербург, Северный пр., д. 1, лит. А.

Тел.: +7 812 325-9825

Zarya Yana Vladimirovna

194354, Saint Petersburg, Severny prosp., 1, lit.

Tel.: +7 812 325-9825 

yana.zarya@fmc-ag.ruГуревичК. Я.GurevichK. Yа.

Проф. Гуревич Константин Яковлевич

115054, Москва, ул. Валовая д. 35

Тел.: +7(495) 789-64-54 

Prof. Gurevich Konstantin Yakovlevich

115054, Moscow, 35 Valovaya Street

Tel.: +7(495) 789-64-54 

Konstantin.Gurevich@fmc-ag.ruhttps://orcid.org/0000-0001-9159-6177ПлавинскийС. Л.PlavinskiiS. L.

Проф. Плавинский Святослав Леонидович, кафедра педагогики, философии и права

191015, Санкт-Петербург, ул. Кирочная, д. 41

Тел.: +7(812) 9630521

SPIN-код: 5660-4661 

Prof. Plavinsky Svyatoslav Leonidovich, Department of Pedagogy, Philosophy and Law

191015, Saint Petersburg, 41  Kirochnaya str.

Теl: +7(812) 9630521

SPIN-код: 5660-4661 

s.plavinskij@szgmu.ruООО «Центр Диализа Санкт-Петербург»Россия«CENTER OF DIALYSIS St. PETERSBURG»Russian Federation«FRESENIUS MEDICAL CARE, Россия»Россия«FRESENIUS MEDICAL CARE Russia»Russian FederationСеверо-Западный государственный медицинский университет им. И.И. МечниковаРоссияNorth-Western State Medical University named after I. I. MechnikovRussian Federation2022180220222615768Copyright © Заря Я.В., Гуревич К.Я., Плавинский С.Л., 20222022Заря Я.В., Гуревич К.Я., Плавинский С.Л.Zarya Y.V., Gurevich K.Y., Plavinskii S.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/2081

ЦЕЛЬ. Выявить возможную связь индивидуальных антропометрических, лабораторных данных и параметров назначенного режима лечения с лучшей выживаемостью при использовании метода гемодиафильтрации ON-LINE (ГДФ OL).ПАЦИЕНТЫ И МЕТОДЫ. Проведен ретроспективный анализ базы данных пациентов EuCliD, получавших лечение методом ГДФ OL в режиме постдилюции в 27 центрах Fresenius Medical Care в РФ в течение 2014 г. Сравнивали данные выживших (9616) и умерших (370) больных. Анализируемые показатели: пол, возраст, стаж лечения, масса тела, индекс массы тела (BMI), площадь поверхности тела (BSA), объем общей воды организма (TBW), объем распределения мочевины (V Urea BCM), наличие сахарного диабета (СД), ишемической болезни сердца (ИБС), сердечной недостаточности (СН), а также параметры процедуры: эффективное недельное время диализа, Кt/V, эффективный инфузионный объем (EIV), эффективный конвекционный объем (ECV). РЕЗУЛЬТАТЫ. К факторам риска смерти у больных с ХБП 5Д, получающих лечение методом ГДФ OL, можно отнести мужской пол, пожилой возраст, сопутствующие заболевания (ИБС, СН, СД), более низкие значения массы тела и ИМТ, меньшее эффективное недельное время диализа, меньшие значения EIV и ECV, Кt/V, более высокие концентрации в сыворотке крови кальция, b2-микроглобулина и СРБ, гипоальбуминемию, низкий уровень гемоглобина. При сравнении BSA, TBW, V Urea BCM показателей, нормализованных к ИМТ, были выделены те из них, которые ассоциировались с высоким риском смертности в популяции диализных пациентов. ЗАКЛЮЧЕНИЕ. Выделены два нормализованных отношения (медиана отношения эффективного инфузионного объема к площади поверхности тела и медиана отношения эффективного конвекционного объема к площади поверхности тела), которые ассоциировались с высоким риском смертности в популяции диализных пациентов.

Hemodiafiltration on-line (HDF OL) cannot be considered sufficiently studied in terms of its effect on the outcome. THE AIM. To identify the possible relationship of individual anthropometric, laboratory data and parameters of the prescribed treatment regimen with better survival when using the HDF OL. PATIENTS AND METHODS. A retrospective study of the EuCliD database of patients treated with HDF OL in 27 Fresenius Medical Care centers in the Russian Federation during 2014 was conducted. All patients received postdilution HDF OL procedures at least 3 times a week, lasting at least 12 hours a week, with adequacy of Kt/V procedures of at least 1,4. Data from survivors (9616) and deceased (370) patients were compared. The analyzed indicators were: gender, age, treatment experience, body weight, body mass index (BMI), body surface area (BSA), total body water volume (TBW), the volume of distribution (V Urea BCM), presence of diabetes mellitus, coronary heart disease, heart failure, as well as the parameters of the procedure: effective weekly dialysis time, Kt/V, effective in-fusion volume (EIV), effective convection volume (ECV). RESULTS. Risk factors for death in patients with CKD 5D treated with HDF OL include male gender, older age, con-comitant diseases, lower body weight, and BMI, shorter effective weekly dialysis time, lower EIV and ECV values, Kt/V, higher hypercalcemia, hypoalbuminemia, lower hemoglobin levels, higher b2-microglobulin levels, and CRP. Сomparing the normalized BMI, BSA, TBW, V Urea BCM indicators, we identified those that were associated with a high risk of mortality in the population of dialysis patients. CONCLUSION. As a result of this work, two normalized ratios were identified (the median ratio of effective infusion volume to body surface area and the median ratio of effective convection volume to body surface area), which were associated with a high risk of mortality in the population of dialysis patients.

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The authors declare that there are no conflicts of interest present.