内源性再输注血液滤过对维持性血液透析患者微量营养素状态的影响：一项随机交叉试验

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-08-30 DOI:10.1016/j.clnu.2025.08.031

Bo Yang , Zewei Chen , Cheng Xue , Changhao Zhu , Dan Ye , Qing Shao , Fanzhou Zeng , Nanmei Liu

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引用次数: 0

摘要

背景微量营养素缺乏在维持性血液透析（MHD）患者中很常见，可能导致不良的临床结果。内源性再灌注血液滤过（HFR）整合了对流、扩散和吸附，潜在地比传统的在线血液滤过（HDF）更好地保存必需营养素。本研究旨在比较HFR和HDF对MHD患者血清微量营养素浓度的急性影响。方法本研究已在chictr.org.cn注册（ChiCTR2500096698）。在这项随机交叉试验中，30名成年MHD患者分别接受HFR和HDF治疗，中间间隔2周的洗脱期，包括他们的标准维持性血液透析。在治疗前后采集血液样本，测定微量元素和维生素浓度。主要终点是治疗后血清碘浓度，用来评估急性透析对碘的清除效率。次要结果包括其他微量元素、水溶性维生素和脂溶性维生素的血清浓度变化。治疗间比较采用线性混合模型（LMM），组内变化采用配对检验。结果共30例患者完成研究，平均年龄55.7±14.8岁，男性63.3%。HFR组与HDF组治疗后血清碘含量差异无统计学意义（校正后平均差异为- 0.019 μmol/L, p = 0.343）。然而，与HDF相比，HFR与血清钙、维生素D3和硒的显著降低相关（p < 0.05）。相比之下，HFR后维生素B3浓度显著升高（p = 0.047）。未发生严重不良事件，两种治疗方式均耐受良好。结论：虽然HFR与HDF在碘清除率方面没有显著差异，但HFR导致钙、维生素D3和硒的损失更大，但导致治疗后血清维生素B3浓度显著升高。这些发现表明，在长期研究显示出明确的净收益之前，在专门研究背景之外常规临床实施HFR似乎为时过早，需要非常谨慎。

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The impact of hemodiafiltration with endogenous reinfusion (HFR) on micronutrient status in patients undergoing maintenance hemodialysis: A randomized crossover trial

Background

Micronutrient deficiencies are common in patients undergoing maintenance hemodialysis (MHD), potentially contributing to adverse clinical outcomes. Hemodiafiltration with endogenous reinfusion (HFR) integrates convection, diffusion, and adsorption, potentially preserving essential nutrients better than traditional online hemodiafiltration (HDF). This study aimed to compare the acute effects of HFR and HDF on serum micronutrient concentrations in MHD patients.

Methods

The research has been registered in chictr.org.cn (ChiCTR2500096698). In this randomized crossover trial, 30 adult MHD patients received one session each of HFR and HDF, separated by a 2-week washout period consisting of their standard maintenance hemodialysis. Blood samples were collected pre- and post-treatment for trace elements and vitamin concentrations. The primary outcome was post-treatment serum iodine concentration, chosen to assess the acute dialytic clearance efficiency of iodine. Secondary outcomes included changes in serum concentrations of other trace elements and water- and fat-soluble vitamins. Linear mixed models (LMM) were used for between-treatment comparisons, and paired tests for within-group changes.

Results

A total of 30 patients (mean age 55.7 ± 14.8 years; 63.3 % male) completed the study. No significant difference was observed in post-treatment serum iodine between HFR and HDF (adjusted mean difference: −0.019 μmol/L, p = 0.343). However, HFR was associated with significantly greater reductions in serum calcium, vitamin D3, and selenium, compared to HDF (p < 0.05 for all). In contrast, vitamin B3 concentrations were significantly higher after HFR (p = 0.047). No serious adverse events occurred, and both modalities were well-tolerated.

Conclusions

While HFR did not significantly differ from HDF in iodine clearance, it resulted in greater losses of calcium, vitamin D3, and selenium, but resulted in significantly higher post-treatment serum concentrations of vitamin B3. These findings suggest that until long-term studies demonstrate a clear net benefit, the routine clinical implementation of HFR outside of dedicated research contexts appears premature and requires significant caution.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.