Hemofiltration

Abstract

For the past four years we have been studying the clinical effects of hemofiltration (HF), and found out that HF treatment is quite effective against dysdialysis syndrome, since solute kinetics of HF, quite different from that of hemodialysis (HD), induces physiologically more natural mass-transfer between the body fluid compartments.
Chronic renal failure is expressed as all kinds of metabolic disorders. Therefore, efforts to improve such metabolic disorder should be studied in order to evaluate the effects of HD and HF. We have already reported that in HF patients, generation rate of urea as well as that of guanidinosuccinic acid and methylguanidine were lowered. Not only blood concentration but also intercellular concentration of the latter two compounds were significantly lowered when compared with HD patients. It was suggested that HF has better effect on protein and amino acid metabolism. In the present study, the carbohydrate metabolism which is indispensable to the maintenance of cell life is investigated.
6 patients each from HD and HF with averaged 30 month treatment and 6 normal volunteers were selected and comparison was made between the 3 groups. Their body weight was within 2.5% range from the standard and subject with diabetes mellitus was excluded.
0.5/kg of intravenous glucose tolerance test (ivGTT) was started from 9A.M. on these 3 fasted groups. Blood sugar and immuno-reactive insulin (IRI) were measured at regular time interval.
There was no significant difference in blood sugar curve between 3 groups. K value of HD and HF groups as the result of ivGTT were 1.5±0.31 (M±S.D.) and 2.6±1.11, respectively, which showed no significant difference. However, in the serum IRI level, HD group showed significantly higher value (P<0.05) at 3, 10, 20 and 30 minutes after glucose load. The insulin/glucose ratio was also significantly high at 20 and 30 minutes in HD group.
The tolbutamide loading test showed no significant difference in the insulin secretion responsiveness between 3 groups.
In conclusion, the carbohydrate metabolism disorder in the end stage of chronic renal failure seemed to have been improved with insulin over-secretion by hemodialysis therapy. However, insulin sensitivity and glucose utilization in the peripheral, target organ and cell was shown to be more improved in HF treatment than in HD.