高通量血液透析的临床应用实践.ppt

Changes of endotoxins during MHD Serum endotoxins level change during HFHD and LFHD HD time(min) Gong Dehua, et al. Chinese Critical Care Medicine,, 2001 Serum IL-1 level change during HFHD and LFHD HD time(min) Gong Dehua, et al. Chinese Critical Care Medicine,, 2001 Changes of cytokines during MHD Changes of cytokines during HFHD Serum TNF-α level change during HFHD and LFHD HD time(min) Gong Dehua, et al. Chinese Critical Care Medicine,, 2001 Japan （1999) Jinling Hospital （2005） 1Y 81.9% 92.421% 5Y 60.7% 72.57% 10Y 42.8% 60.71% Survival rate of MHD in 1254patients Ji daxi .CJN 2005 High-Flux 趋势... HD HFHD HDF Low-Flux 谢谢 谢谢! * * * * * * * * * * * * * * * * * * * * 更少的材料=高通透性 中空滤丝束的3维结构 * * 高通量透析: 降低LMW AGEs Makita et al, 1994 为什么应用高通量血液透析？ 保存残余肾功能 减少炎症反应 减少血管性病变 改善脂质代谢 延迟透析相关淀粉样变性 改善营养 降低住院率,并发症和死亡率 Improvement of lipid profile *p0.05 vs time 0 and 4 weeks time [weeks] Modified Cellulose Polyflux S 0 20 40 60 80 100 120 0 4 12 20 28 lipid concentration [mg/dl] 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 ratio LDL/HDL * * * * LDL HDL LDL/HDL Pitone J et al, ISBP, 2003 Modified cellulose versus Polyflux S 43 patients Polyflux: Improvements in lipid profile may help to reduce the lipid lowering medications 为什么应用高通量血液透析？ 保存残余肾功能 减少炎症反应 减少血管性病变 改善脂质代谢 延迟透析相关淀粉样变性 改善营养 降低住院率,并发症和死亡率 1 2 3 4 5 6 7 8 9 10 11 12 HF80S P170H 0 5 10 15 20 25 30 35 40 Ratio (%) b2m/Albumin Patients HF80S P170H Selectivity ?2M / Albumin HDF Post-Dilution Polyflux 170 H: 1.7 m2 PS (HF 80 S): 1.8 m2 Souid et al. ISBP 2003 膜通量和膜材料对淀粉样变性的影响 (Hemo Study) Schiffl et al. Nephrol Dial Transplant 15:1399-1409, 2000 b2m MD=11,800D Prevention of b2m-related amyloidosis by high-flux therapies 0 0,2 0,4 0,6 0,8 1 Relative amyloidosis risk Low-flux HD High-flux HD HDF Risk of a worse therapeutic effect Japanese Dialysis Patient Registry (N=1196) Ref: Nakai et al AJKD 2001 为什么应用高通量血液透析？ 保存残余肾功能 减少炎症反应 减少血管性病变 改善脂质代谢 延迟透析相关淀粉样变性 改善营养 降低住院率,并发症和死亡率 高通量透析对血清白蛋白的影响 (HEMO study) Marcus et al