不同频率血液透析滤过联合高通量血液透析治疗对糖尿病肾病维持性血液透析患者肾功能、微炎症状态及左心功能的影响

doi:10.3969/j.issn.1006-5725.2025.21.015

Abstract

Abstract:

Objective To investigate the effects of different hemodiafiltration （HDF） frequencies combined with high-flux hemodialysis （HFHD） on renal function， micro-inflammatory status， and left ventricular function in patients with diabetic nephropathy who have undergone maintenance hemodialysis （MHD）. Methods A total of 120 patients with diabetic nephropathy undergoing MHD between January 2022 and December 2024 were enrolled in the study and randomly divided into a study group and a control group using a random number table method， with 60 patients in each group. Both groups received HFHD. The control group received hemodiafiltration （HDF） once a month， whereas the study group received HDF once a week. The study evaluated the two groups in terms of therapeutic efficacy， renal function indices， calcium-phosphorus metabolism indices， micro-inflammatory status， left ventricular function indices， and the incidence of adverse reactions. Results The total response rate in the study group was significantly higher than that in the control group （P < 0.05）. Following treatment， the levels of serum creatinine （Scr）， cystatin C （Cys C）， and 24-hour urine protein quantification （24hUP） in the study group were significantly lower than those in the control group （P < 0.05）. After treatment， the blood calcium level in the study group was higher， whereas the blood phosphorus level was lower compared to the control group （P < 0.05）. Additionally， post-treatment levels of interleukin-8 （IL-8）， IL-6， and tumor necrosis factor-α （TNF-α） in the study group were significantly reduced in comparison to the control group （P < 0.05）. The study group also exhibited improved cardiac function after treatment， as evidenced by a higher left ventricular ejection fraction （LVEF）， and reduced left ventricular end-diastolic diameter （LVDD） and left ventricular end-systolic diameter （LVSD） compared to the control group （P < 0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups ［8.33% （5/60） vs. 11.67% （7/60）， P > 0.05］. Conclusion Combining once-weekly HDF with HFHD can enhance therapeutic outcomes and renal function， promote the recovery of calcium-phosphorus metabolism， alleviate the micro-inflammatory state， and improve left ventricular function in MHD patients with diabetic nephropathy.

Key words: maintenance hemodialysis, high-flux hemodialysis, diabetic nephropathy, hemodiafiltration, renal function, micro-inflammatory state, left ventricular function

CLC Number:

R459.5

Jing GAO,Jin ZHAO,Fan WANG,Kang. LIU. Effects of different frequencies of hemodiafiltration combined with high⁃flux hemodialysis on renal function， micro⁃inflammatory state and left ventricular function in patients with diabetic nephropathy after maintenance hemodialysis[J]. The Journal of Practical Medicine, 2025, 41(21): 3398-3404.

Figures/Tables 10

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References 25

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项目	观察组（n = 60）	对照组（n = 60）	χ² /t值	P值
性别			0.307	0.580
男	36（60.00）	33（55.00）
女	24（40.00）	27（45.00）
年龄（x ± s）/岁	57.86 ± 6.53	59.14 ± 6.07	1.112	0.268
体质量指数（x ± s）/（kg/m²）	23.37 ± 1.92	23.64 ± 2.05	0.745	0.458
吸烟史	28（46.67）	25（41.67）	0.304	0.581
饮酒史	21（35.00）	18（30.00）	0.342	0.559
透析龄（x ± s）/年	4.11 ± 1.17	3.98 ± 1.04	0.643	0.521
空腹血糖（x ± s）/（mmol/L）	7.48 ± 0.81	7.55 ± 0.73	0.497	0.620
糖化血红蛋白（x ± s）/%	8.29 ± 0.67	8.41 ± 0.70	0.959	0.339
高血压	14（23.33）	16（26.67）	0.178	0.673
高血脂	6（10.00）	9（15.00）	0.686	0.408

组别	例数	显效	有效	无效	总有效
观察组	60	24（40.00）	32（53.33）	4（6.67）	56（93.33）
对照组	60	14（23.33）	34（56.67）	12（20.00）	48（80.00）
χ² 值					4.615
P值					0.032

组别	例数	Scr/（μmol/L）		Cys C/（mg/L）		24 hUP/（g/24 h）
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	60	692.21 ± 80.69	368.41 ± 52.37^?	1.83 ± 0.51	0.97 ± 0.27^?	2.03 ± 0.53	1.09 ± 0.34^?
对照组	60	689.75 ± 84.03	456.96 ± 60.85^?	1.79 ± 0.48	1.28 ± 0.33^?	1.95 ± 0.49	1.40 ± 0.41^?
t值		0.164	8.544	0.442	5.632	0.858	4.508
P值		0.870	< 0.001	0.659	< 0.001	0.392	< 0.001

组别	例数	血钙		血磷
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	60	1.75 ± 0.38	2.33 ± 0.52^?	2.53 ± 0.57	1.61 ± 0.36^?
对照组	60	1.81 ± 0.41	2.09 ± 0.47^?	2.48 ± 0.53	1.93 ± 0.45^?
t值		0.831	2.652	0.498	4.301
P值		0.407	0.009	0.620	< 0.001

组别	例数	IL-8		IL-6		TNF-α
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	60	85.13 ± 20.46	40.68 ± 10.35^?	70.82 ± 16.97	33.04 ± 8.65^?	102.57 ± 26.84	50.95 ± 14.26^?
对照组	60	84.07 ± 21.83	52.92 ± 14.96^?	72.26 ± 18.45	47.95 ± 11.73^?	104.19 ± 29.03	63.87 ± 18.59^?
t值		0.274	5.212	0.445	7.9245	0.317	4.271
P值		0.784	< 0.001	0.657	< 0.001	0.752	< 0.001

Effects of different frequencies of hemodiafiltration combined with high⁃flux hemodialysis on renal function， micro⁃inflammatory state and left ventricular function in patients with diabetic nephropathy after maintenance hemodialysis

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组别	例数	LVEF/%		LVDD/mm		LVSD/mm
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	60	53.79 ± 4.58	60.21 ± 5.09^?	57.03 ± 3.68	50.26 ± 3.14^?	37.45 ± 3.06	31.39 ± 2.35^?
对照组	60	55.11 ± 4.35	57.83 ± 4.76^?	56.41 ± 3.92	53.19 ± 3.45^?	36.67 ± 3.21	34.04 ± 2.84^?
t值		1.619	2.645	0.893	4.865	1.362	5.569
P值		0.108	0.009	0.374	< 0.001	0.176	< 0.001