VAI TRÒ CỦA PHƯƠNG PHÁP LỌC MÁU HDF ONLINE TRONG KẾT QUẢ ĐIỀU TRỊ THIẾU MÁU Ở BỆNH NHÂN BỆNH THẬN MẠN GIAI ĐOẠN CUỐI LỌC MÁU CHU KỲ KÉM ĐÁP ỨNG VỚI ĐIỀU TRỊ THIẾU MÁU

Abstract

compare the role of Online hemodiafiltration (Online HDF) with conventional haemodialysis (HD) in the treatment outcomes of anemia in end-stage renal disease (ESRD) patients undergoing regular hemodialysis with poor response to anemia treatment. Subjects and methods: A prospective descriptive study was conducted on 120 ESRD patients undergoing regular hemodialysis with poor response to anemia treatment at Can Tho City General Hospital from October 2022 to October 2023. The patients were divided into two groups: 60 patients undergoing hemodialysis using the HDF Online method once every 1.5 months alternating with HD, and 60 patients undergoing hemodialysis using the HD method. Results: No statistically significant differences were found between the two groups regarding common characteristics including age, gender, BMI, duration of dialysis, history of hypertension and diabetes mellitus, as well as initial average erythropoietin dose, hematological parameters and basic biochemical parameters. After 6 months of intervention, the red blood cell count and hemoglobin concentration significantly increased in the Online HDF group compared to the HD group (p<0.05). Additionally, the erythropoietin resistance index (ERI) significantly decreased in the Online HDF group compared to the HD group (p<0.05). No significant changes were observed between the two groups in ferritin levels post-intervention. In comparison, Online HDF showed superior efficacy over HD in improving serum albumin levels (p<0.001). Regarding middle molecule clearance, serum PTH and β₂-microglobulin levels decreased more in the Online HDF group compared to the HD group (p<0.05). The initial Kt/V index showed no significant difference between the two groups, but after 6 months of intervention, the Kt/V index in the Online HDF group significantly increased compared to the HD group (p<0.05). Conclusions: HDF Online method improves the poor response to anemia treatment in ESRD patients, as evidenced by a substantial reduction in the erythropoietin resistance index (ERI). It also demonstrates better clearance of middle molecular weight substances (represented by β₂-microglobulin and PTH). Moreover, Online HDF has demonstrated superior effectiveness compared to conventional HD in improving the nutritional status of ESRD patients.