Efficacy of high-flux hemodialysis combined with hemoperfusion in the treatment of uremia
10.3760/cma.j.cn341190-20240705-00870
- VernacularTitle:高通量血液透析联合血液灌流治疗尿毒症的效果观察
- Author:
Mingxiang WENG
1
;
Yufang LI
1
;
Chunya LIU
1
Author Information
1. 温州医科大学附属衢州医院 衢州市人民医院肾内科，衢州 324000
- Publication Type:Journal Article
- Keywords:
Uremia;
Renal dialysis;
Parathyroid hormone;
Beta 2-microglobulin;
Vascular cell adhesion molecule-1;
Immunoglobulins;
Complement C3;
Complement C4
- From:
Chinese Journal of Primary Medicine and Pharmacy
2025;32(3):397-403
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of high-flux hemodialysis combined with hemoperfusion in patients with uremia.Methods:Eighty patients with uremia who received treatment at the Quzhou Hospital Affiliated to Wenzhou Medical University (Quzhou People's Hospital) from January 2020 to December 2022 were selected for this prospective randomized controlled trial. Participants were grouped using a random number table method, with 40 patients in the study group receiving high-flux hemodialysis combined with hemoperfusion, and 40 patients in the control group receiving high-flux hemodialysis alone. Toxicity clearance, calcium-phosphate metabolism, immune function, and vascular endothelial function were assessed using competitive enzyme-linked immunosorbent assay, immunofluorescence assay, fully automated biochemical analyzers, and immunoturbidimetric assay. The differences in toxicity clearance, calcium-phosphate metabolism, immune function, and vascular endothelial function were compared between the two groups.Results:Compared with before treatment, both groups showed a significant decrease in parathyroid hormone (PTH), blood creatinine, β 2-microglobulin, blood urea nitrogen, blood phosphorus, advanced glycation end products (AGEs), intercellular adhesion molecule-1 (ICAM-1), and homocysteine (Hcy) after treatment. Specifically, PTH levels decreased from (353.28 ± 50.26) ng/L to (235.26 ± 31.51) ng/L in the control group and from (357.17 ± 52.18) ng/L to (174.16 ± 26.35) ng/L in the study group; blood creatinine decreased from (969.47 ± 110.44) μmol/L to (511.57 ± 91.96) μmol/L in the control group and from (957.58 ± 121.99) μmol/L to (414.37 ± 87.41) μmol/L in the study group; β 2-microglobulin decreased from (40.27 ± 7.98) mg/L to (22.06 ± 3.26) mg/L in the control group and from (41.65 ± 8.40) mg/L to (17.70 ± 3.43) mg/L in the study group; blood urea nitrogen decreased from (30.64 ± 5.63) mmol/L to (14.02 ± 2.80) mmol/L in the control group and from (30.04 ± 5.90) mmol/L to (10.07 ± 1.94) mmol/L in the study group; blood phosphorus decreased from (2.23 ± 0.49) mmol/L to (1.80 ± 0.36) mmol/L in the control group and from (2.26 ± 0.53) mmol/L to (1.53 ± 0.31) mmol/L in the study group ; Hcy decreased from (35.87 ± 5.34) μmol/L to (30.93 ± 4.65) μmol/L in the control group and from (36.21 ± 5.27) μmol/L to (20.26 ± 4.53) μmol/L in the study group; ICAM-1 decreased from (574.96 ± 56.81) ng/L to (419.87 ± 40.76) ng/L in the control group and from (569.84 ± 52.37) ng/L to (384.51 ± 35.12) ng/L in the study group; AGEs levels decreased from (330.41 ± 43.69) mg/L to (297.64 ± 38.59) mg/L in the control group and from (326.98 ± 41.25) mg/L to (165.42 ± 15.74) mg/L in the study group. Conversely, compared with before treatment,blood calcium, immunoglobulin G, immunoglobulin M, immunoglobulin A, CD 4+, CD 4+/CD 8+ ratio, complement 3, and complement 4 all increased after treatment. Specifically, blood calcium increased from (1.90 ± 0.43) mmol/L to (2.27 ± 0.32) mmol/L in the control group and from (1.93 ± 0.46) mmol/L to (2.61 ± 0.36) mmol/L in the study group; IgG increased from (7.73 ± 1.56) g/L to (9.21 ± 2.04) g/L in the control group and from (7.82 ± 1.62) g/L to (10.7 ± 2.02) g/L in the study group; IgM increased from (0.42 ± 0.07) g/L to (1.29 ± 0.11) g/L in the control group and from (0.40 ± 0.08) g/L to (1.52 ± 0.08) g/L in the study group; IgA increased from (0.44 ± 0.16) g/L to (1.54 ± 0.25) g/L in the control group and from (0.48 ± 0.19) g/L to (1.93 ± 0.38) g/L in the study group; CD 4+ increased from (32.77 ± 5.71)% to (38.18 ± 4.92)% in the control group and from (32.11 ± 5.34)% to (46.07 ± 4.95)% in the study group; the CD 4+/CD 8+ ratio increased from (1.07 ± 0.14) to (1.29 ± 0.15) in the control group and from (1.07 ± 0.17) to (1.61 ± 0.26) in the study group; C3 increased from (0.80 ± 0.12) g/L to (1.01 ± 0.20) g/L in the control group and from (0.79 ± 0.14) g/L to (1.19 ± 0.23) g/L in the study group; and C4 increased from (0.32 ± 0.15) g/L to (0.67 ± 0.17) g/L in the control group and from (0.33 ± 0.14) g/L to (0.86 ± 0.12) g/L in the study group. All these differences were statistically significant between the two groups ( t = 12.01, 19.47, 33.98, 33.72, 17.64, 20.36, 22.75, 24.28, 19.25, 22.77, 4.71, 29.54, 32.01, 27.39, -5.06, -11.39, -4.79, -9.65, -61.55, -97.13, -36.63, -32.21, -7.71, -16.90, -5.78, -11.34, -9.21, -13.28, -13.25, -33.73, all P < 0.05). Additionally, when compared with the control group, the study group showed superior results ( t = -9.40, -4.84, -5.82, -7.33, -3.59, -10.40, -4.16, -20.07, 4.47, 3.28, 5.43, 7.14, 6.73, 3.73, 5.76, all P < 0.05). Conclusions:High-flux hemodialysis combined with hemoperfusion for the treatment of uremia can effectively improve calcium and phosphorus metabolism and vascular endothelial function, as well as enhance immune function and toxicity clearance rate.
