肾脏病学与治疗学杂志

??? (RT) ???????????????????????????????? 4% ? 8%????????????????????????????????????????????????????????????????????????? RT ?????????????????????? III ??????????????????????????

???????????????????????????????????????????????????????????????????????????????????????????? 2016 ? 3 ? 1 ?? 4 ? 30 ???????? 2 ???????????????????????? 3 ????? 3 ??????????????? 18 ?????????????? KDQOL SF????????????1.3 ???????????????????????????? Wilcoxon ? Kruskal-Wallis ????? 2 ?????????????????????????????????????????????????????? 94 ????????????? 79 ??64 ????64?????????????? 43.3 ± 14.9 ??64 ?????? KDQOL SF 36 ????? 8 ????????????????????????????????“????”?54.9??????????“?????????????”???? 92.8???????????????“?????????????”???41.0????????“?????????”?????? 68.0??? KDQOL???????????“????”???????“?????????”????????????“????”???????16.0??“??????”?????87.7???“??????”???????93.8????????83.3??p=0.02???????“???”???55.8 vs 96.1?p=0.006??“?????”?74.8 vs. 87.2?p=0, 01?????????????????????????????????????????????????????????????????????????

Background: Unfractionated heparin (UFH) administered during hemodialysis (HD) has cumulative adverse effects; hence the importance of using the lowest possible dose and avoid overdosing. Methods: We analyzed 30 patients with chronic hemodiafiltración (HDF) treatment divided in 3 groups: pos filter HDF with heparin standard impregnation dose (27 ± 6.5 IU/kg), HDF pos filter with impregnation low dose (15 ± 4.2 IU/ kg); in both groups, heparin impregnation and maintenance were given, and a third group HDF pre-dilution only with heparin impregnation dose (27 ± 12.8 IU/kg). We measured partial thromboplastin time (aPTT) and serum heparin levels at 30 and 190 min, in the three groups. Results: HDF pre-dilution group received a significantly lower total dose than the other 2 groups; 1750 vs. 2650/3444 UI/Kg (p<0.001), maintaining 30 min aPTT target (55.6 ± 43.4) as aPTT 190 min (44.4 ± 30.3), as well as effectiveness of the treatment (substitution volume of 51.4 ± 11.8 L, Ktv 1.38 ± 0.3). The other two groups reached aPTT 30 min target, but decreased towards the end of HDF sessions (aPTT 190 min). HDF pre-dilution did not increase clot formation (p<0.678). There were no major coagulation or bleeding events in any of the HDF sessions. Conclusion: Pre dilution HDF with only impregnation heparin is a safe and effective method; after the amplification and reproduction of our results, it could represent an alternative treatment that minimizes UFH doses in order to reduce the associated adverse events.

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