Clinical effectiveness of intermittent infusion hemodiafiltration using backfiltration of ultrapure dialysis fluid compared with predilution on-line hemodiafiltration : a prospective, multicenter, and controlled trial

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  • 逆濾過透析液を用いた間歇補充型HDFと前希釈法On-line HDFの臨床評価
  • 逆濾過透析液を用いた間歇補充型HDFと前希釈法On-line HDFの臨床評価 : 多施設共同前向き比較研究
  • ギャクロカ トウセキエキ オ モチイタ カンケツホジュウガタ HDF ト ゼン キシャクホウ On-line HDF ノ リンショウ ヒョウカ : タシセツ キョウドウ マエムキ ヒカク ケンキュウ
  • —多施設共同前向き比較研究—

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Intermittent infusion hemodiafiltration (I-HDF) has been introduced to improve the peripheral circulation of dialysis patients and to reduce the occurrence of hypotension during hemodialysis treatment. The clinical effectiveness of I-HDF, however, has not been clarified in comparison with that of other on-line HDF therapies. A prospective, multicenter, parallel group comparative trial was carried out to reveal the clinical effectiveness of I-HDF compared with predilution on-line HDF (Pre-HDF), which is currently the most popular on-line HDF therapy in Japan. Patients were allocated to two groups after matching for age (±5 y.o.), dry weight (±5 kg), and with/without diabetes. After obtaining informed consent, 36 patients, namely, 18 pairs, participated in this clinical trial. During the trial, we evaluated the clinical condition and quality of life (QOL) of the patients and solute removal characteristics. The results showed no difference in clinical condition and QOL score between the two groups. The reduction ratio of the systolic blood pressure originally showed no difference between the two groups, but it decreased slightly as the trial proceeded after changing from hemodialysis therapy. There was also no difference in the number of treatments by medical staff, but this also significantly decreased as the trial proceeded in both groups. On the other hand, the Pre-HDF group demonstrated significantly higher removal rates of β2-microglobulin and α1-microglobulin than the I-HDF group. At the same time, the amount of albumin leakage in treatment was also significantly larger in Pre-HDF than in I-HDF. In conclusion, the clinical condition and QOL of patients undergoing I-HDF were not inferior to those having Pre-HDF. Furthermore, Pre-HDF demonstrated a significantly higher removal rate for medium-sized and larger solutes and larger albumin leakage in comparison with I-HDF.

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