血液透析滤过课件.ppt

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1、HDF与常规血透的比较林星辉文献复习近年新的RCT研究Meta分析结论与反思HDF能否改善血透患者的预后？Prospective randomized cross-over long-term comparison of online haemodiafiltration and ultrapure high-fluxhaemodialysisEurJMedRes. 2007Jan31;12(1):26-33prospective crossoverclinicalevaluation76patientswere randomized to hi

2、gh-flux haemodialysis or onlinehaemodiafiltration (24months)andswitchedtothealternativetreatment(24months).RESULTS:Removalofurea(Kt/V)andphosphatewassignificantlygreaterfor online haemodiafiltration thanfor haemodialysis.Both high-fluxhaemodialysis and haemodiafiltration were

3、associatedwithsustainedreductionsofpretreatmentbeta2microglobulinlevels,however,thedecreasewasgreaterwith haemodiafiltration.BothmodesofrenalreplacementtherapysignificantlyimprovednutritionalstatusandthehaematopoieticresponsetorHuEPO.Underunmatchedconditions(sodiumandenergyba

4、lance) haemodiafiltration wasassociatedwithalowernumberofhypotensiveepisodesandpartialimprovementofqualityoflife.Theincidenceofdeathwaslowinbothgroupsanddidnotdifferamongthetwomodesofrenalreplacementtherapy.Long-term outcomes inonlinehemodiafiltrationandhigh-fluxhemodialysis:

5、acomparativeanalysisClinJAmSocNephrol. 2009Dec;4(12):1944-53858incidentpatientsRetrospectivestudiesSurvivalcomparisonsHDFvsHighFluxHD-SurvivalDataVilarE.LongtermoutcomesinHDFandHD.ClinJAmSocNephrol,2009HemofiltrationandHemodiafiltrationReduceIntradialyticHypotensioninESRDFran

6、cescoLocatellietal.JAmSocNephrol21:1798–1807,2010.LocatelliFetal.JASN2010;21:1798-1807©2010byAmericanSocietyofNephrologyMorepatientsshiftoutofHFthanothertreatmentmodalities.LocatelliFetal.JASN2010;21:1798-1807©2010byAmericanSocietyofNephrologyCONTRAST-TheDutchConvectiveTransp

7、ortStudyProspective,randomized,multicentertrialwith714patientstreatedwithon-lineHDForlow-fluxHDandfollowedupforamean3yearsPrimaryoutcome:allcausemortality,fatal&non-fatalCVeventsThemainsecondaryendpointwasacompositeofmajorcardiovascularevents近年新的RCT研究：JASN,23:1087-1096,2012CO

8、NTRAST:DutchHDFRCT,Pre-dialysisß2-microglobulinlevelsCONTRAST:DutchH