Comparison of Hemodiafiltration and Hemodialysis in Patients with End Stage Renal Disease

master's thesis

• Title (croatian): Usporedba hemodijafiltracije i hemodijalize u pacijenata s terminalnom bubrežnom bolesti
• Author: Nicola Michael Beat Willi Pohly
• Mentor: Ivica Horvatić (mentor)
• Committee member: Ivica Horvatić (predsjednik povjerenstva)
• Committee member: Joško Mitrović (član povjerenstva)
• Committee member: Ivana Vuković Brinar (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

The most common and widely used form of dialysis is hemodialysis. Throughout time new forms of dialysis and combinations out of existing methods were invented. The problem is where do the newer methods like hemodiafiltration fit in and which niche could they conquer. This study is a single center, case control study in a group of 68 patients with end stage renal disease (45 patients on hemodialysis, 25 patients on hemodiafiltration). We present structured analysis of in total 47 parameters, of which 43 were deemed essential for dialysis control and 4 counted as addition for an overview of inflammatory and cardiovascular biomarkers. The results indicate that hemodialysis and hemodiafiltration performed in our Department are equal methods regarding removal of uremic toxins, showing no significant differences in clearance ratios. Major differences were observed in N-Terminal pro Brain-type Natriuretic Peptide, which showed an increased net filtration in the patients treated with hemodiafiltration compared to hemodialysis (p.adj = 0.00073). Out of 68 patients, 53 of them had relevant comorbidities (68.8% in hemodialysis group and 92.0% in hemodiafiltration group), with no statistically significant difference between the groups. Hemodiafiltration provides an alternative to hemodialysis regarding the removal of uremic toxins with similar clinical efficacy. There are potential benefits of performing hemodiafiltration in patients with end stage renal disease and comorbidities affecting the cardiovascular system compared to patients receiving hemodialysis. The outcome shown by NT-proBNP levels may lead to the suggestion that hemodiafiltration should be preferred in patients with active cardiovascular disease.

Abstract (croatian)

Najčešće korišteni oblik dijalize je hemodijaliza. Tijekom vremena razvijali su se novi oblici dijalize te kombinirale već postojeće metode. Postavlja se pitanje gdje smjestiti novije metode kao što je hemodijafiltracija te koji postojeći oblik dijalize bi one mogle zamijeniti. U ovom radu opisana je slučaj-kontrola studija u koju je uključeno 68 bolesnika s terminalnom bubrežnom bolesti liječenih dijalizom u KB Dubrava (45 bolesnika hemodijalizom, 25 bolesnika hemodijafiltracijom). Prikazani su podaci o ukupno 47 promatranih parametara od kojih se njih 43 smatra ključnim za kontrolu dijalize, a ostalih 4 pripada skupini inflamatornih i kardiovaskularnih biomarkera. Nakon analize dobijenih rezultata može se zaključiti kako su hemodijaliza i hemodijafiltracija u našoj ustanovi jednako uspješne metode za odstranjivanje uremijskih toksina (nije nađena statistički značajna razlika među klirensima). Najznačajnije razlike uočene su u koncentraciji NT-proBNP-a gdje se vidi veća neto filtracija kod bolesnika koji su liječeni hemodijafiltracijom u usporedbi s hemodijalizom (p.adj = 0.00073). Od ukupno
68 bolesnika njih 53 je imalo značajne komorbiditete (69.8% u skupini hemodijalize te 92.0% u skupini hemodijafiltracije), bez statistički značajne razlike između skupina. Hemodijafiltracija se pokazala kao alternativa hemodijalize s obzirom na uklanjanje uremijskih toksina s gotovo jednakim kliničkim ishodima. Postoje određene prednosti korištenja hemodijafiltracije kod bolesnika s terminalnom bubrežnom bolesti i komorbiditetima koji zahvaćaju srce i krvožilni sustav u usporedbi s hemodijalizom. Iz usporedbe razina NTproBNP- a može se zaključiti kako bi metoda izbora kod tih bolesnika možda trebala biti hemodijafiltracija.

• Keywords: Hemodiafiltration; Hemodialysis; End Stage Renal Disease; Dialysis; Nephrology
• Keywords (croatian): hemodijafiltracija; hemodijaliza; terminalna bubrežna bolest; dijaliza; nefrologija
• Language: english
• URN:NBN: urn:nbn:hr:105:160957
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-21 07:55:06