[Comparative analysis of the efficacy and biocompatibility of various methods of dialysis].
OBJECTIVE
The efficacy and biocompatibility of hemodialysis have a singnificant impact on dialysis patient morbidity and mortality rate. The aim of our study was to compare the efficacy and biocompatibility of different hemodialysis modalities in our patients.


METHODS
A total of 55 patients were included in the study, and on the basis of dialysis modality, they were divided in four groups: group I--post-dilution on-line hemodiafiltration (n=15), group II--bicarbonate high-flux polysulphone hemodialysis (n=15), group III--bicarbonate low-flux polysulphone hemodialysis (n=15), and groupe IV--bicarbonate cuprophane hemodialysis (n=10). The efficacy was evaluated on the basis of urea reduction rate (URR), urea Kt/V index and serum beta2-microglobuline reduction rate, and the biocompatibility was evaluated on the basis of the leukocyte count fall during the first fiftheen minutes of dialysis session, and of the serum C-reactive protein (CRP) level.


RESULTS
The highest mean URR was achieved in the group I (70.53 +/- 6.49%), and it was significantly higher in comparison with the average URR in the group IV (54.8 +/- 6.35%) (p = 0.001). The average value of urea Kt/V index in the group I (1.48 +/- 0.22) was significantly higher in comparison with the average value in the group II 1.30 +/- 0.22 (p < 0.05), group III (1.05 +/- 0.22), and group IV (0.98 + 0.22) (p = 0.001). Serum beta2-microglobuline reduction rate was 68.93 +/- 8.25% in the group I, and 58.86 +/- 7.98% in the groupe II (p = 0.01). During the first 15 minutes of hemodialysis the leukocyte number was decreased by 12.57 +/- 9.35% in the group 1, 13.61 +/- 9.64% in the group 11, 18.3 +/- 13.24 in the group III and 62.3 +/- 15.4 in the group IV, on average. The mean serum level of CRP was 9.4 +/- 6.47 mg/l in the group IV, and less than 3.5 mg/l in the group I of the patients (p = 0.001).


CONCLUSIONS
Postdilution on-line hemodiafiltration in comparison with standard hemodialysis provided the more effective elimination of small and middle uremic toxins molecules and a significantly higher degree of biocompatibility. The patients treated with standard hemodialysis frequently do not achieve the minimal value of urea Kt/V index prescribed by National Kidney Foundation-Dialysis Outcomes Quality Inatiatives standards. These patients also have significantly higher serum CRP values which suggest the state of chronic microinflammation.
Zivanović
Milenko
M
Zdravstveni centar, Sluzba za nefrologiju i dijalizu, Srbija i Crna Gora. vvesna@eunet.yu
Hrvacević
Rajko
R
Kovacević
Zoran
Z
Veljancić
Ljubisa
L
Vujanić
Svetlana
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D002482:Cellulose / Q000031:analogs & derivatives; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011108:Polymers; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D013450:Sulfones; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism
D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700; D014508:Urea; D002482:Cellulose; C009865:cuprammonium cellulose