مقایسه‌ی اثر صافی‌های High-Flux و Low-Flux بر کفایت همودیالیز در بیماران مبتلا به بیماری کلیوی مرحله‌ی نهایی تحت همودیالیز

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دستیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران

2 استادیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران

3 دانشیار، گروه آمار زیستی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی شهرکرد، شهرکرد، ایران

4 استاد، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: همودیالیز رایج‌ترین روش درمان جایگزینی نارسایی مزمن کلیه به شمار می‌رود و دیالیز ناکافی سبب افزایش مرگ و میر بیماران می‌شود؛ لذا، کفایت دیالیز در این بیماران از اهمیت زیادی برخوردار است. این مطالعه، به منظور مقایسه‌ی کفایت همودیالیز در صافی‌های High-flux و Low-flux در یک مرکز دیالیز انجام گردید و رابطه‌ی آن با برخی شاخص‌های آزمایشگاهی بیماران تحت همودیالیز بررسی شد.روش‌ها: پژوهش پیش رو، به صورت کار آزمایی بالینی تصادفی شده با استفاده از تفاوت‌های صافی‌ها و همچنین، اثر اولترافیلتراسیون در دفع سموم بین 42 نفر از بیماران تحت همودیالیز با صافی‌های Low-flux و High-flux انجام گردید. بیماران مرحله‌ی نهایی بیماری مزمن کلیه (End-stage renal disease یا ESRD) با میزان اولترافیلتراسیون بیشتر از 3 لیتر، با قرار گیری در 2 گروه به صورت متقاطع در 2 ماه تحت همودیالیز با صافی‌های High-flux و Low-flux قرار گرفتند و شاخص‌های لازم جهت اندازه‌گیری Kt/V در هر بار همودیالیز و سایر اندکس‌های آزمایشگاهی در ابتدا و انتهای هر ماه در آن‌ها مورد ارزیابی قرار گرفت. سپس، تجمیع نهایی داده‌های بیماران در این دو ماه مقایسه شد و یافته‌ها با استفاده از نرم‌‌افزار SPSS، تحلیل گردید.یافته‌ها: تفاوت آماریِ معنی‌داری در کفایت دیالیز، بین دو گروه دیده شد. یافته‌های تجمیعی برای بیماران تحت همودیالیز با صافی High-flux و Low-flux نشان داد که اگر چه در هر دو گروه، کفایت دیالیز در حد مطلوب از نظر استانداردهای تعریف شده برای کفایت دیالیز بود ولی Kt/V به طور معنی‌داری در همودیالیز با صافی High-flux نسبت به همودیالیز با صافی Low-flux بیشتر بود (013/0 = P).نتیجه‌گیری: این مطالعه نشان داد که صافی‌های High-flux، نسبت به Low-flux، در حجم‌های بالاتر از 3 لیتر اولترافیلتراسیون، در افزایش میانگین کفایت دیالیز نقش بیشتری داشتند؛ پیشنهاد ما برای پژوهش‌های آتی، ارزیابی تأثیر استفاده‌ی طولانی مدت صافی‌های High-flux در بیماران تحت همودیالیز بر کفایت دیالیز، بهبود کیفیت زندگی و کاهش میزان بستری آن‌ها و اثر آن در کاهش هزینه‌های درمانی بیماران می‌باشد؛ تا بدین وسیله، هزینه- فایده (Cost-benefit) استفاده‌ی دراز مدت از صافی‌های High flux نیز سنجیده شود.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of High-Flux and Low-Flux Hemodialysis Filters on Hemodialysis Adequacy in Under-Hemodialysis Patients with End-Stage Renal Disease

نویسندگان [English]

  • Hamid Nasri 4
  • Mohadeseh Pour-Pouneh 1
  • Saeed Mardani 2
  • Soleiman Kheiri 3
1 Resident, Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 Assistant Professor, Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
3 Associate Professor, Department of Biostatics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
4 Professor, Department of Nephrology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Hemodialysis is the most common alternative therapy in chronic renal failure and inadequate dialysis increases the mortality of patients; thus, the dialysis adequacy in these patients is important. This study aimed to compare the adequacy if hemodialysis high-flux and low-flux filters in Hospital Dialysis Centers of Shahrekord University of Medical Sciences, Iran, and assess its relation to other indices for patients with chronic and end-stage renal disease (ESRD).Methods: In a randomized clinical trial, 42 patients were performed with low-flux and high-flux filters. So, the patients with end-stage chronic kidney disease, with the rate of ultrafiltration of more than 3 liters, in the two cross groups underwent hemodialysis with high- and low-flux filters in 2 months. The indicators for measuring the Kt/V in each dialysis and other lab indices at the beginning and the end of each month were measured and compared using SPSS software.Findings: At the end of the intervention, significant difference in adequacy of dialysis was observed between the two groups of high- and low-flux filtration. Although, both groups of patients had adequacy of dialysis in terms of defined standards, but the findings showed that Kt/V in hemodialysis significantly was lower in high-flux group (P = 0.013).Conclusion: This study showed that the high-flux filters in higher volumes of 3 liters of ultrafiltration, increases the average dialysis adequacy more than the low-flux filters. We suggest future studies to assess the impact of long-term use of high-flux filters on dialysis efficacy, improved quality of life and reduced hospitalization rate in hemodialysis patients and its effect on reducing healthcare costs; patients are thereby cost-benefited in using high-flux filters for long term.

کلیدواژه‌ها [English]

  • End-stage renal disease
  • Dialysis
  • Ultrafiltration

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مجله دانشکده پزشکی اصفهان
دوره 33، شماره 331 - شماره پیاپی 331
خرداد و تیر 1394
صفحه 563-573

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  • تاریخ دریافت: 20 بهمن 1393
  • تاریخ بازنگری: 12 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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