POREĐENJE EFIKASNOSTI UKLANJANJA UREMIJSKIH TOKSINA SREDNJE MOLEKULSKE MASE IZMEĐU VISOKOPROPUSNE HEMODIJALIZE I POSTDILUCIONE ONLINE HEMODIJAFILTRACIJE
Sažetak
UVOD. Konvencionalna visokopropusna hemodijaliza efikasno uklanja uremijske toksine srednje molekulske mase od 0,5-15 (20) kDa, dok postdiluciona online hemodijafiltracija efikasno uklanjaju uremijske toksine srednje molekulske mase u rasponu od 0,5-60 kDa. CILJ. Rad je imao za cilj da uporedi efikasnost uklanjanja β2-mikroglobulina iz seruma bolesnika u toku pojedinačne sesije konvencionalne visokopropusne hemodijalize i postdilucione online hemodijafiltracije. METOD. Ispitano je 85 bolesnika koji su lečeni konvencionalnom visokopropusnom hemodijalizom i 30 bolesnika koji su lečeni postdilucionom online hemodijafiltracijom. Glavni parametar za procenu efikasnosti uklanjanja uremijskih toksina srednje molekulske mase bila je koncentracija β2-mikroglobulina u serumu pre i nakon pojedinačne sesije konvencionalne visokopropusne hemodijalize i postdilucione online hemodijafiltracije. Za statističku analizu korišćeni su: Kolmogorov-Smirnov test, Studentov T test i Mann-Whitney U test. REZULTATI. Kod bolesnika koji su lečeni postdilucionom online hemodijafiltracijom, prosečan ukupni konvektivni volumen je iznosio 21,38 ± 2,97 litara po sesiji. Indeks redukcije β2-mikroglobulina za dijaliznu membranu FX CorDiax 600 iznosio je 61,76 ± 7,32%, za dijaliznu membranu FX CorDiax 800 74,69 ± 6,51%. Indeks redukcije albumina za membranu FX CorDiax 600 iznosio je 3,48 ± 1,28%, za dijaliznu membranu FX CorDiax 800 6,01 ± 2,97%. Između indeksa redukcije albumina, za dva različita dijalizna modaliteta i dve različite dijalizne membrane, postoji visoko statistički značajna razlika (p < 0,01). ZAKLJUČAK. Postdiluciona online hemodijafiltracija je efikasnija u uklanjanju β2-mikroglobulina iz seruma bolesnika, u odnosu na konvencionalnu visokopropusnu hemodijalizu. Gubitak albumina u toku pojedinačne sesije visokopropusne hemodijalize je manji u odnosu na pojedinačnu sesiju postdilucione online hemodijafiltracije. Kod oba modaliteta dijalize, gubitak albumina je manji od 4,0 g/4h. Visokopropusna hemodijalize efikasno sprečava razvoj amiloidoze povezane sa dijalizom, dok postdiluciona online hemodijafiltracija efikasno sprečava ne samo razvoj amiloidoze povezane sa dijalizom, već i razvoj rezistencije na dejstvo eritropoetina i aterosklerotskih kardiovaskularnih bolesti u populaciji bolesnika koji se leče redovnom dijalizom.
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