الفهرس 
Chronic kidney diseaseOnly 14 pages are availabe for public view
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Abstract
Renal replacement therapy (RRT) replaces nonendocrine kidney function in
patients with renal failure and is occasionally used for some forms of poisoning.
Techniques include continuous hemofiltration and hemodialysis, intermittent hemodialysis,
and peritoneal dialysis. All modalities exchange solute and remove fluid from the blood,
using dialysis and filtration across permeable membranes.
The choice of technique depends on multiple factors, including the primary need
(eg, solute or water removal or both), underlying indication (eg, acute or chronic kidney
failure, poisoning), vascular access, hemodynamic stability, availability, local expertise,
and patient preference and capability (eg, for home dialysis).
Based on these considerations the OL-HDF concept By combining diffusive and
convective clearances, HDF offered the most efficient modality to clear small and middle
uremic toxins.
Several studies have shown that HDF provides significantly higher body clearances
than high-flux hemodialysis both for small and middle molecule solutes .
In this modality, the amount of ultrafiltration (UF) exceeds the desired fluid loss, and
replacement fluid is administered to achieve the target fluid balance. The relative
contribution of convection to overall solute removal increases progressively with
increasing molecular weight.
Prevention and correction of hyperphosphatemia is a major goal of chronic kidney
disease–mineral and bone disorder (CKD–MBD) management, achievable through
avoidance of a positive phosphate balance.
Using a mixed diffusive–convective hemodialysis tecniques, and increasing the
number and/or the duration of dialysis tecniques are all measures able to enhance
phosphorus (P) mass removal through dialysis.
In our study, we studied 99 patients divided into 2 groups.
group (1) included 59 patient were on heamodilysis .
group (2) included 40 patient were on haemodiafiltration.
In our study , we found a highly statistical significant difference (P value <0.001)
between 2 groups regarding the mean of (PTH). By comparison between the two groups
we found a significant difference in The level of Parathyroid Hormone as a high level of
PTH with HD in comparison with HDF.
In our study , we found a highly statistical significant difference (P value <0.000)
between 2 groups regarding the mean of S.Phosphrus and by the way Ca * Po4 level.
By comparison between the two groups we found a significant difference in The level
of S.Phosphrus as a high level of Po4 with HD in comparison with HDF .
We found a significant difference in The level of Albumin as the level of Albumin
with HDF (mean 3.36 ± 0.21) in comparison with HD (mean 3.39 ± 0.21).
As we know that Middle molecules, consisting mostly of peptides and small proteins
with molecular weight the range of 500-60,000 Da, accumulate in renal failure and
contribute to the uraemic toxic state. Β2-Microglobulin (Β2-MG) with a molecular weight
Summary
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of 11,000 is considered representative of these middle molecules. This convective
component of high-flux dialysis can be enhanced in a predictable way by haemodiafi
ltration (HDF).
In our study, we found by a comparison between the two groups we found a
significant difference in The level of B2 Microglobulin as a high level of with HD VS in
HDF and this revealed an inverse correlation between the β2-microglobulin level and the
duration of HDF.
So Long-term HDF further reduced β2-microglobulin levels, thus, it may provide an
improved modality for renal replacement therapy.
So we encourage Long-term HDF which may provide an Optimum modality as renal
replacement therapy for prevention of Carpal Tunnel Syndrome , HDF can clinically
reduce the incidence of dialysis related amyloidosis.