RESUMEN
With the introduction of the on-line preparation of dialysis fluids, the hemofiltration technique, which has never had a widespread diffusion in its old version with the infusion bags, has gained a new interest. We planned a prospective, randomized, 3-year-long study comparing survival and morbidity in ultrapure bicarbonate dialysis (BD) with on-line predilution hemofiltration (HF). Since comorbidity is one of the main factors limiting survival, the study was addressed to patients with a severe degree of comorbidity. The paper presents the preliminary results of the trial. Sixty-four patients were enrolled and randomized to either BD (N = 32) or HF (N = 32). Mean age and dialysis vintage were comparable. Twenty patients died during the study, 12 in BD and 8 in HF. The relative risk of death was 11% higher in patients treated with BD compared to those in the HF group (p < 0.005). The number of hospitalisation events per single patient was lower, even though not significantly, in HF compared to BD (1.94 + 1.26 in HF vs 2.48 + 1.98 in BD, p = NS). As concerns biochemistry, apart from beta-2-microglobulin, any other substantial difference was not found during the study, though the small solute concentration was generally a little more elevated in HF than in BD. Dialysis hypotension showed a trend to decrease in both the dialysis modalities up to near half of the trial, then, during the last year, it remained quite stable in HF, while, on the contrary, it increased in the BD group. By the end of the protocol, patients in HF showed a 2.5% incidence of acute dialysis hypotension, while patients in BD had 23%.
Asunto(s)
Bicarbonatos/uso terapéutico , Hemofiltración/métodos , Diálisis Renal , Anciano , Sangre/metabolismo , Hemodinámica , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Morbilidad , Análisis de Supervivencia , Microglobulina beta-2/sangreRESUMEN
Recently much interest has been focused on the phenomena produced by the interaction between blood and dialytic membranes. The aim of this study was to evaluate beta 2-M, Il-2 and TNF changes in relation to the long-term use of different membranes (CU, PAN-AN69, PMMA, PS) and different dialytic treatments (HD, HDF, AFB). Plasma beta 2-M was significantly increased in patients dialysed with CU compared to synthetic membranes, and decreased in AFB compared to HD and HDF. Intradialytic changes of beta 2-M, corrected for haemoconcentration, resulted in a significant increase with CU and PMMA, while a decrease was found with PAN-AN69 and PS and during convective treatments, more evident during haemofiltration performed with sterile dialysate without acetate. I1-2R was increased in all patients compared to normal subjects, without any intradialytic change, regardless of the type of membrane used. TNF was in the normal range. The different decrease of beta 2-M observed with synthetic membranes, the stable intradialysis I1-2 R values during HD performed with membranes non-permeable to endotoxins and during AFB, and the absence of detectable TNF support the hypothesis that dialysate plays an important role in activating beta 2-M and cytokines, together with other factors.
Asunto(s)
Interleucina-2/sangre , Diálisis Renal , Factor de Necrosis Tumoral alfa/metabolismo , Microglobulina beta-2/metabolismo , Anciano , Femenino , Humanos , Masculino , Membranas Artificiales , Persona de Mediana Edad , Factores de TiempoRESUMEN
The importance of the urine volume and the residual functional capacity of the kidneys has been emphasized by several authors in connection with preservation of the quality of life of patients having to undergo chronic dialysis therapy. Since it has been found that muzolimine can increase diuresis even in patients with extremely high uraemia (GFR values less than 5 ml/min), a group of 16 patients (10 haemodialysis patients, HD, and 6 peritoneal dialysis patients, CAPD) was treated daily with 90 mg for a period of one year, commencing with the start of dialysis therapy. The aim of the study was to monitor the diuresis and to evaluate any changes in the quality of life. The latter were assessed on the basis of clinical criteria by the scheme of Ravid et al. The results were compared with the results obtained from another group of 16 patients (10 HD and 6 CAPD) who had likewise been on dialysis for a year but without receiving diuretic therapy. The two groups were homogeneous in age, sex, aetiology of the kidney disease, and renal function. Even though diuresis, like the residual renal function, normally deteriorates in the course of time owing to the underlying kidney disease, the administration of muzolimine showed that the compound is able to induce statistically significantly higher diuresis in the treated patients in the first year of dialysis compared with the untreated patients. In addition it was possible to preserve the residual kidney function established at the start of the dialysis therapy, which corresponds to a significantly improved quality of life.