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Titolo Why is on-line haemodiafiltration necessary as a renal replacement therapy option in chronic kidney disease patients?
Autore B. Canaud
Referenza Port J Nephrol Hypert 2007: 21 (3): 000-000
Contenuto INTRODUCTION It has been clearly shown over the last three decades that conventional haemodialysis (HD) is a very efficacious form of treatment which has increased the lifespan of more than one and half million chronic kidney disease stage 5 (CKD-5) patients worldwide. In contrast to this success story, the high morbidity and mortality rate still persisting in dialysis patients is, however, the upcoming renal replacement therapy (RRT) challenge. Further, it is frustrating for clinicians to note that despite major technical advances (among which are high-flux membranes, bicarbonate buffered dialysis fluid, ultrafiltration controlled machines, biocompatible material) and leading therapeutic achievements (correction of anaemia by erythropoietic stimulating agents (ESAs), correction of hyperlipidemia and so on) in RRT, there have been no significant progress in patient outcomes. The increasing prevalence of dialysis-related pathology, including β2M-amyloidosis, accelerated atherosclerosis, left ventricular hypertrophy, ageing and malnutrition in long term treated patients, are other factors contributing to the partial failure of conventional RRT. While the precise causes of this dialysis-related pathology are not fully known, it can be speculated that several mechanisms contribute to the outcome. To some extent, pathophysiologic mechanisms combine four main factors: limited clearance of middle solutes leading to the accumulation of middle and large uraemic toxins; poor biocompatibility of the dialysis system responsible for the periodic activation of cells and protein systems resulting in a microinflammation state; unphysiologic profile of intermittent treatment leading to alternate peaks and troughs and unfavourable correction of the milieu interieur composition, leaving metabolic disturbances such as permanent oxidative and carbonyl stress condition.
Data 21.06.2007
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