nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2013-17-1-70-72nefr-536Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОН-ЛАЙН ГЕМОДИАФИЛЬТРАЦИЯ И УДАЛЕНИЕ ФОСФАТОВ У БОЛЬНЫХ С ТЕРМИНАЛЬНОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ, ПОЛУЧАЮЩИХ ЛЕЧЕНИЕ ГЕМОДИАЛИЗОМON-LINE HEMODIAFILTRATION AND PHOSPHATE REMOVAL IN END STAGE RENAL DISEASE PATIENTS ON HEMODIALYSISЗорчеваР. И.ZortchevaR. Y.

Варна

zortcheva@mail.bgИкономовВ. Х.IkonomovV. Ch.ПаскалевД. Н.PaskalevD. N.Клиника нефрологии и диализа, Медицинский университет ВарныBulgaria2013100120131717072Copyright © Зорчева Р.И., Икономов В.Х., Паскалев Д.Н., 20132013Зорчева Р.И., Икономов В.Х., Паскалев Д.Н.Zortcheva R.Y., Ikonomov V.C., Paskalev D.N.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/536

ЦЕЛЬ ИССЛЕДОВАНИЯ. Контроль гиперфосфатемии с помощью кальций- и алюминий-содержащих фосфат-связывающих препаратов приводит к развитию других осложнений, таких как гипокальциемия, кальцификация мягких тканей и сосудов, кальцифилаксии. Применение препаратов, не содержащих кальций/алюминий и кальцимиметиков, очень дорого. Целью исследования было сравнить эффективность удаления фосфатов в течение пред- и постдилюционной он-лайн гемодиафильтрации (ГДФ), а также сравнить эффективность удаления фосфатов во время ГДФ с разными объемами замещающего раствора. ПАЦИЕНТЫ И МЕТОДЫ. В исследование были включены 13 пациентов c терминальной почечной недостаточностью (ТПН). Было проведено 49 ГДФ – 41 с замещением 8600 мл и 8 – с замещением 12000 мл (ГДФ-8600 и ГДФ-12000). Рассчитывались фосфат-Kt/v (Daugirdas 2-го поколения) и коэффициент снижения фосфатов (КС) (%). РЕЗУЛЬТАТЫ. Удаление фосфатов, согласно Kt/v во время пред- и постдилюционной ГДФ-8600 было одинаковым: 0,915 ± 0,304 (n=24) и 0,908 ± 0,234 (n=17) соответственно, р=НД. КС фосфатов (%), полученный с помощью упомянутых методик ГДФ-8600, было 52,02 ±12,28 (n=24) и 51,900±10,810 (n=17), р=НД. Во время постдилюционной ГДФ-12000 удаление фосфатов было ниже, чем при постдилюционной ГДФ-8600: Kt/v=0,689±0,009 (n=8) против 0,908±0,234 (n=17), p<0,001 и КС=43,62±5,870 (n=8) против 51,900±10,810 (n=17), р<0,001 соответственно. ЗАКЛЮЧЕНИЕ. (1) Не выявлено различий в удалении фосфатов при расчете Kt/v при сравнении пред- или постдилюционной ГДФ-8600. (2). По данным Kt/v и КС, удаление фосфатов более эффективно при ГДФ-8600 в сравнении с ГДФ-12000 мл.

THE AIM. The control of hyperphosphatemia by calcium- or aluminium- containing phosphate-binders leads to other complications like hypocalcemia, soft tissue/vascular calcifications, calciphylaxis. The application of non-calcium- non-alluminium-containing phosphate-binders and calcimimetics is very expensive. The aim of the study was to compare phosphate removal during preand post-dilutional on-line hemodiafiltration (HDF) as well as to compare phosphate removal during HDF with different volume of substitutional solution. PATIENTS AND METHODS. 13 end stage renal disease patients (ESRDP) were included in the study. 49 HDF were realized – 41 with substitution of 8600 ml and 8 – with 12000 ml (HDF-8600 and HDF-12000). Phosphate-Kt/v (Daugirdas 2nd generation) and phosphate-Reduction Ratio (RR; %) were calculated. RESULTS. Phosphate removal according to Kt/v during pre-dilutional and post-dilutional HDF-8600 was similar: 0.915±0.304 (n=24) and 0.908±0.234 (n=17) respectively, P=NS. Phosphate RR (%) achieved by mentioned modalities of HDF 8600 was 52.02±12.28 (n=24) and 51.900±10.810 (n=17), P=NS. During post-dilutional HDF-12000, phosphate removal was lower than that during post-dilutional HDF-8600: Kt/ v=0.689±0.009 (n=8) versus 0.908±0.234 (n=17), P<0.001 and RR=43.62±5.870 (n=8) versus 51.900±10.810 (n=17), P<0.01, respectively. CONCLUSION. (1).There is no difference between phosphate removal during pre- and post-dilutional HDF-8600 according to Kt/v. (2). Phosphate removal is more effective in HDF-8600 compared to HDF-12000 ml according to Kt/v and RR.

терминальная почечная недостаточность (ТПН)он-лайн гемодиафильтрациягемодиализгиперфосфатемияend stage renal disease (ESRD)on-line hemodiafiltrationhemodialysishyperphosphatemiaReferencesBlock GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15, 2208-2218Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004; 15, 2208-2218Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and Ca×P product with mortality risk in chronic hemodialysis patients: A national study, Am J Kidney Dis 1998; 31(4): 607-617Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and Ca×P product with mortality risk in chronic hemodialysis patients: A national study, Am J Kidney Dis 1998; 31(4): 607-617Young EW, Albert JM, Satayathum S et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2005; 67; 1179-1187Young EW, Albert JM, Satayathum S et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2005; 67; 1179-1187Ketteler M, The control of hyperphosphatemia in chronic kidney disease: Which phosphate binder? Int J Artif Organs 2009; 32: 95-105Ketteler M, The control of hyperphosphatemia in chronic kidney disease: Which phosphate binder? Int J Artif Organs 2009; 32: 95-105Block GA, Port FK, Re-evaluation of risk associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 2000; 35(6):1226-1237Block GA, Port FK, Re-evaluation of risk associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 2000; 35(6):1226-1237Chertow GM, Burke SK, Raggi P; Treat to Goal Working Group, Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 2002; 62: 245-252Chertow GM, Burke SK, Raggi P; Treat to Goal Working Group, Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 2002; 62: 245-252Kambova L, Ionova D, Kirijakov Z, Aluminium overload influences cognitive function in patients on dialysis. J Nephrol Dialysis & Transplant 1994; l 9 (9): 1357Kambova L, Ionova D, Kirijakov Z, Aluminium overload influences cognitive function in patients on dialysis. J Nephrol Dialysis & Transplant 1994; l 9 (9): 1357Locatelli F, Manzoni C, Vigano S et al. Hemodiafiltration – state of the art, In: Kawanishi H, Yamashita AC, eds, Hemodiafiltration – A new era. Contrib Nephrol Karger, Basel, 2011, Vol 168; 5-18Locatelli F, Manzoni C, Vigano S et al. Hemodiafiltration – state of the art, In: Kawanishi H, Yamashita AC, eds, Hemodiafiltration – A new era. Contrib Nephrol Karger, Basel, 2011, Vol 168; 5-18Wizemann V, Lotz C, Techert F, Uthoff S. On-line haemodiafiltration versus low-flux haemodialysis, A prospective randomized study. Nephrol Dial Transplant 2000; 15 [suppl 1]: 43-48Wizemann V, Lotz C, Techert F, Uthoff S. On-line haemodiafiltration versus low-flux haemodialysis, A prospective randomized study. Nephrol Dial Transplant 2000; 15 [suppl 1]: 43-48Zehnder C, Gutzwiller JP, Renggli K, Hemodiafiltration – a new treatment option for hyperphosphatemia in hemodialysis patients. Clin Nephrol 1999; 52: 152-159Zehnder C, Gutzwiller JP, Renggli K, Hemodiafiltration – a new treatment option for hyperphosphatemia in hemodialysis patients. Clin Nephrol 1999; 52: 152-159Minutolo R, Bellizzi V, Cioffi M et al. Postdialytic rebound of serum phosphorus: pathogenetic and clinical insights. J Am Soc Nephrol 2002; 13:1046-1054Minutolo R, Bellizzi V, Cioffi M et al. Postdialytic rebound of serum phosphorus: pathogenetic and clinical insights. J Am Soc Nephrol 2002; 13:1046-1054Lornoy W, De Meester J, Because I et al, Impact of convective flow on phosphorus removal in maintenance on hemodialysis patients. J Ren Nutr 2006; 16: 47-53Lornoy W, De Meester J, Because I et al, Impact of convective flow on phosphorus removal in maintenance on hemodialysis patients. J Ren Nutr 2006; 16: 47-53Schiffl H, Prospective randomized cross-over long-term comparison of online haemodiafiltration and ultrapure high-flux haemodialysis. Eur J Med Res 2007; 12: 26-33Schiffl H, Prospective randomized cross-over long-term comparison of online haemodiafiltration and ultrapure high-flux haemodialysis. Eur J Med Res 2007; 12: 26-33

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