不同血液透析方式对维持性血液透析患者铁调素清除的影响。

Effect of different hemodialysis modalities on hepcidin clearance in patients undergoing maintenance hemodialysis.

机构信息

Department of Nephrology, Xuzhou Central Hospital, Xuzhou Medical University, Xuzhou, China.

Xuzhou Medical University, Xuzhou, China.

出版信息

Semin Dial. 2023 May-Jun;36(3):240-246. doi: 10.1111/sdi.13110. Epub 2022 Jul 3.

DOI:10.1111/sdi.13110

PMID:35785435

Abstract

INTRODUCTION

Hepcidin is a master regulator of iron utilization and takes part in the pathophysiology of anemia in maintenance hemodialysis (MHD) patients. Hepcidin is a moderate-molecular-weight substance and partially binds to plasma proteins in the circulation, which theoretically might be removed efficiently by hemoperfusion (HP). This study aimed to compare the effect of different dialysis modalities on hepcidin removal and discuss its effect on the iron and anemia status in MHD patients.

MATERIALS AND METHODS

In a longitudinal interventional study of 26 stable MHD patients, the serum hepcidin, β2-microglobulin (β2-MG), and intact parathyroid hormone (iPTH) were measured before and after one treatment session of hemodialysis (HD), hemodiafiltration (HDF), HD + HP, and HDF + HP, separately. One-way analysis of variance (ANOVA) was used to identify the effect of dialysis modalities on the intra-dialysis clearance ratios.

RESULTS

The combined dialysis modalities (HD + HP and HDF + HP) achieved greater clearance ratios of serum hepcidin than HD and HDF alone, HD + HP vs. HD (16 ± 15% vs. 4 ± 13%, p < 0.001), HDF + HP vs. HDF (18 ± 5% vs. 10 ± 13%, p = 0.0036). Similarly, the combined dialysis modalities also performed better than HD and HDF alone in removing β2-MG. There was no significant difference in iPTH clearance among these four modalities, except that HDF + HP achieved a greater clearance ratio than HD. Furthermore, the anemia was improved after the 6-month treatment with regular HD/HDF plus HP, which was indicated by increasing hemoglobin (p = 0.0004) and reduction of erythropoiesis-stimulating agents (ESAs) resistance index (ERI) (p = 0.0431).

CONCLUSIONS

Our findings suggest that the combined dialysis modalities of HD/HDF plus HP could achieve better clearance ratios of hepcidin than HD/HDF alone, thereby, might improve iron utilization, and benefit anemia management in MHD patients. Further studies with larger sample-size patients and longer follow-up duration are still needed.

摘要

简介

铁调素是铁利用的主要调节剂，参与维持性血液透析（MHD）患者贫血的病理生理学。铁调素是一种中等分子量的物质，在循环中部分与血浆蛋白结合，理论上可以通过血液灌流（HP）有效地清除。本研究旨在比较不同透析方式对铁调素清除的影响，并探讨其对 MHD 患者铁和贫血状态的影响。

材料与方法

在 26 例稳定的 MHD 患者的纵向干预性研究中，分别在血液透析（HD）、血液透析滤过（HDF）、HD+HP 和 HDF+HP 治疗后测量血清铁调素、β2-微球蛋白（β2-MG）和完整甲状旁腺激素（iPTH）。采用单因素方差分析（ANOVA）比较透析方式对内源性铁调素清除率的影响。

结果

联合透析方式（HD+HP 和 HDF+HP）比单独 HD 和 HDF 清除血清铁调素的清除率更高，HD+HP 与 HD 相比（16±15%比 4±13%，p<0.001），HDF+HP 与 HDF 相比（18±5%比 10±13%，p=0.0036）。同样，联合透析方式在清除β2-MG 方面也优于单独 HD 和 HDF。这四种方式在清除 iPTH 方面没有显著差异，除了 HDF+HP 比 HD 清除率更高。此外，经过 6 个月的常规 HD/HDF 加 HP 治疗，贫血得到改善，表现为血红蛋白升高（p=0.0004）和促红细胞生成素抵抗指数（ERI）降低（p=0.0431）。