Nephrology Dialysis Transplantation, Vol 13, Issue 4 955-961, Copyright © 1998 by Oxford University Press
G Verzetti, C Navino, R Bolzani, G Galli and G Panzetta
Background: Morbidity and mortality rates in diabetic
patients on regular dialysis treatment (RDT) are higher than in
non-diabetic-subjects on RDT. Moreover diabetic patients experience an
intradialytic morbidity unacceptably higher than in patients with other
causes of terminal renal failure. The aim of the present investigation was
to compare standard bicarbonate haemodialysis (BHD) with acetate-free
biofiltration (AFB) in a group of 41 diabetic patients stable on dialysis
treatment for 25±22 months. Methods: Twenty
four type II and 17 type I diabetic patients, all requiring insulin
therapy, were included and were followed for 1 year in a 6-month cross-over
randomized study for both methods. The analysis was carried out on dialysis
symptoms, interdialysis symptoms, and nutritional status, and the
multivariate analysis of variance for repeated measures on the same
subjects in the two techniques was used. Results: AFB
significantly reduced dialytic and extradialytic symptoms (P=0.003 and
0.001 respectively). Cardiovascular collapses decreased by 43%, and other
dialysis symptoms showed a similar trend (-35%). The interdialysis symptoms
decreased by 28% and were accompanied by an increase in subjective
wellbeing (39%) when patients were switched from traditional haemodialysis
to AFB. Acid-base control was better with AFB (P=0.01), both at the
beginning and during the session. Slightly significant differences were
also obtained for Kt/V (AFB 1.48±0.29 vs
BHD 1.38±0.30), while no significant difference was noted with
respect to sodium mass balance, nutritional status, calorie-protein intake,
nPCR, blood glucose profile, and insulin requirements. The number of
hospital admissions and the mortality rate, which were much lower during
the AFB than the BHD period, were not analysed statistically.
Conclusions: AFB allows better control of some
metabolic aspects, reduces intra- and extradialysis symptoms, and improves
patient quality of life. Whether the long-term prognosis can be improved by
AFB remains to be established with further studies. Key
words: acetate-free biofiltration; bicarbonate haemodialysis;
diabetic nephropathy; morbidity rates; RDT
ORIGINAL ARTICLES
Acetate-free biofiltration versus bicarbonate haemodialysis in the treatment of patients with diabetic nephropathy: a cross-over multicentric study
Divisione di Nefrologia e Dialisi, Ospedale Maggiore della Carita, Novara, Italy; Dipartimento di Statistica, Universita di Modena, Italy; Servizio di Nefrologia e Dialisi, Ospedale Maggiore, Trieste, Italy; Corresponding author
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