Clinical Curative Effect of High Flux Hemodialysis on Diabetic Nephropathy and Impact on Patients' Insulin Resistance_West China Medical Journal

Authors：

 NieXiaodong , HuXinan , LiSimeng

Department of Nephrology, the Fourth People's Hospital of Yibin, Yibin, Sichuan 644001, P. R. China;

Corresponding author：

Keywords：

High flux hemodialysis; Diabetic nephropathy; Clinical efficacy; Insulin resistance

DOI：

10.7507/1002-0179.201600364

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Objective To explore the clinical curative effect of high flux hemodialysis on diabetic nephropathy (DN) and impact on patients' insulin resistance (IR). Methods A total of 96 patients with DN meeting the inclusion criteria treated between January 2013 and January 2014 were selected. The patients were randomly divided in to the observation group and control group with 48 in each. The control group received low flux hemodialysis, while the observation group underwent high flux hemodialysis. Before the treatment and in the first half of the year after the treatment, the clinical renal function and inflammatory indexes, lipid metabolism, and glucose metabolism related markers were recorded, and IR index (HOMA-IR) were calculated and compared. Results Before and after the treatment, the Kt/V showed no significant change in the two groups (P > 0.05). Serum creatinine levels was lower after the treatment compared with that before the treatment in both of the two groups; in the observation group, C-reactive protein, interleukin-6 and tumor necrosis factorαwere significantly lower than those before the treatment and than those in the control group after the treatment (P < 0.05). HOMA-IR and fasting insulin levels in the observation group after the treatment were significantly lower than those before the treatment and than those in the control group after the treatment (P < 0.05). No significant changes of fasting plasma glucose and glycosylated hemoglobin levels in the two groups before and after the treatment in patients were found (P > 0.05). Conclusion High flux hemodialysis therapy is effective on DN, which can effectively remove the body and large molecular type of inflammatory mediators, alleviate the micro inflammatory state, improve the IR status and correct the lipid metabolic abnormalities.

Citation： NieXiaodong, HuXinan, LiSimeng. Clinical Curative Effect of High Flux Hemodialysis on Diabetic Nephropathy and Impact on Patients' Insulin Resistance. West China Medical Journal, 2016, 31(8): 1325-1328. doi: 10.7507/1002-0179.201600364 Copy

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4.	毕学青, 姜埃利, 魏芳, 等.高通量透析不同超滤量对溶质清除的影响[J].中国血液净化, 2014, 13(10):713-716.
5.	刘红, 常明, 刘书馨, 等.高通量血液透析改善尿毒症患者的周围神经病变[J].中华肾脏病杂志, 2011, 27(10):779-780.
6.	Yilmaz MI, Sonmez A, Saglam M, et al. Ramipril lowers plasma FGF-23 in patients with diabetic nephropathy[J]. Am J Nephrol, 2014, 40(3):208-214.
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8.	Xu J, Lee ES, Baek SH, et al. Effect of bilirubin on triglyceride synthesis in streptozotocin-induced diabetic nephropathy[J]. J Korean Med Sci, 2014, 29(2):155-163.
9.	崔玲玲, 单新莉, 李虹, 等.糖尿病肾病诱导期透析心血管并发症护理对策[J].中华全科医学, 2014, 12(3):487-488.
10.	Musante L, Tataruch DE, Holthofer H, et al. Use and isolation of urinary exosomes as biomarkers for diabetic nephropathy[J]. Front Endocrinol (Lausanne), 2014, 26(5):149-150.
11.	凌扣荣, 周文芳, 江瑞, 等.糖尿病肾病患者血液透析合并肺部感染的危险因素分析[J].中华医院感染学杂志, 2013, 23(24):5941-5942.
12.	Eknoyan G, Beek G, Cheung A. Hemodialysis (HEMO) Study Group. Effect of dialysis dose and membrane flux in maintenance hemodialysis[J]. N Engl J Med, 2002, 347(19):2010-2019.
13.	Sato E, Amaha M, Nomura M, et al. LDL-apheresis contributes to survival extension and renal function maintenance of severe diabetic nephropathy patients:a retrospective analysis[J]. Diabetes Res Clin Pract, 2014, 3(14):375-381.
14.	谭琴, 刘建彬, 刘娟, 等.糖尿病肾病与非糖尿病肾病患者应用葡萄糖透析液进行持续性非卧床腹膜透析的全天血糖谱比较[J].中华糖尿病杂志, 2013, 5(1):17-22.
15.	Kumar GS, Kulkarni A, Khurana A, et al. Selenium nanoparticles involve HSP-70 and SIRT1 in preventing the progression of type 1 diabetic nephropathy[J]. Chem Biol Interact, 2014, 6(223):125-133.

1. 刘晓斌, 王凉, 刘斌, 等.高通量血液透析对老年糖尿病肾病患者胰岛素抵抗及微炎症状态的影响[J].中华老年医学杂志, 2014, 33(2):159-162.
2. 张豫文, 洪洁.炎症因子与胰岛素抵抗[J].诊断学理论与实践, 2010, 9(1):90-94.
3. Kumar D, Agarwal S, Karoli R, et al. Relationship between carotid intima thickness and silent cerebral infarction in patients with type 2 diabetic nephropathy[J]. J Assoc Physicians India, 2014, 62(4):316-322.
4. 毕学青, 姜埃利, 魏芳, 等.高通量透析不同超滤量对溶质清除的影响[J].中国血液净化, 2014, 13(10):713-716.
5. 刘红, 常明, 刘书馨, 等.高通量血液透析改善尿毒症患者的周围神经病变[J].中华肾脏病杂志, 2011, 27(10):779-780.
6. Yilmaz MI, Sonmez A, Saglam M, et al. Ramipril lowers plasma FGF-23 in patients with diabetic nephropathy[J]. Am J Nephrol, 2014, 40(3):208-214.
7. 向茜, 张弦, 郭燕, 等.糖尿病肾病患者心瓣膜钙化特点分析[J].中华临床医师杂志:电子版, 2014, 3(1):375-379.
8. Xu J, Lee ES, Baek SH, et al. Effect of bilirubin on triglyceride synthesis in streptozotocin-induced diabetic nephropathy[J]. J Korean Med Sci, 2014, 29(2):155-163.
9. 崔玲玲, 单新莉, 李虹, 等.糖尿病肾病诱导期透析心血管并发症护理对策[J].中华全科医学, 2014, 12(3):487-488.
10. Musante L, Tataruch DE, Holthofer H, et al. Use and isolation of urinary exosomes as biomarkers for diabetic nephropathy[J]. Front Endocrinol (Lausanne), 2014, 26(5):149-150.
11. 凌扣荣, 周文芳, 江瑞, 等.糖尿病肾病患者血液透析合并肺部感染的危险因素分析[J].中华医院感染学杂志, 2013, 23(24):5941-5942.
12. Eknoyan G, Beek G, Cheung A. Hemodialysis (HEMO) Study Group. Effect of dialysis dose and membrane flux in maintenance hemodialysis[J]. N Engl J Med, 2002, 347(19):2010-2019.
13. Sato E, Amaha M, Nomura M, et al. LDL-apheresis contributes to survival extension and renal function maintenance of severe diabetic nephropathy patients:a retrospective analysis[J]. Diabetes Res Clin Pract, 2014, 3(14):375-381.
14. 谭琴, 刘建彬, 刘娟, 等.糖尿病肾病与非糖尿病肾病患者应用葡萄糖透析液进行持续性非卧床腹膜透析的全天血糖谱比较[J].中华糖尿病杂志, 2013, 5(1):17-22.
15. Kumar GS, Kulkarni A, Khurana A, et al. Selenium nanoparticles involve HSP-70 and SIRT1 in preventing the progression of type 1 diabetic nephropathy[J]. Chem Biol Interact, 2014, 6(223):125-133.

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Clinical Curative Effect of High Flux Hemodialysis on Diabetic Nephropathy and Impact on Patients' Insulin Resistance

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