Comparative analysis of the efficacy and biocompatibility of various methods of dialysis

Abstract

BACKGROUND/AIM: 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). CONCLUSION: 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.