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HDF\u7d44\u81f3\u5c11\u7d93\u6b77\u4e86\u4e00\u6b21\u4e0d\u826f\u53cd\u61c9\uff0c\u4e14\u5169\u7d44\u6c92\u6709\u986f\u8457\u5dee\u7570\u3002<\/p>\n<p>\u5728\u63a2\u7d22\u6027\u7684\u5206\u6790\u4e2d\uff0c\u900f\u6790\u4e2d\u7684\u5bb9\u5fcd\u5ea6\u4e5f\u88ab\u5206\u6790\uff0c\u7528\u6bcf\u4e00\u6b21\u5be6\u969b\u6cbb\u7642\u7576\u4f5c\u4e00\u500b\u7d71\u8a08\u55ae\u4f4d\u3002\u572811,981\u500b\u6cbb\u7642\u4e2d\uff0c\u67092,935\u500b\u767c\u751f\u81f3\u5c11\u4e00\u6b21\u7684\u4e0d\u826f\u53cd\u61c9\uff0c\u9019\u4e9b\u4e0d\u826f\u53cd\u61c9\u5728Online HDF\u7d44\u88e1\u986f\u8457\u66f4\u4f4e\uff0c\u5305\u542b\u8f03\u5c11\u7684\u900f\u6790\u4e2d\u4f4e\u8840\u58d3\u75c7\u72c0\u8207\u808c\u8089\u62bd\u7b4b\u3002\u76f8\u8f03\u4e4b\u4e0b\uff0c\u5065\u5eb7\u76f8\u95dc\u7684\u751f\u6d3b\u54c1\u8cea\u3001\u5171\u75c5\u7387\u3001\u6b7b\u4ea1\u7387\u5728\u5169\u7d44\u4e26\u6c92\u6709\u986f\u8457\u5dee\u7570\u3002\u5728Online HDF\u7d44\u53ef\u4ee5\u770b\u5230\u63a7\u5236\u4ee3\u8b1d\u6027\u9aa8\u8cea\u75be\u75c5\u7684\u751f\u7269\u6a19\u8a18\u548c\u03b22-microglobulin\u6578\u503c\u7684\u9032\u6b65\uff0c\u4f46\u8840\u6e05\u4e2d\u767d\u86cb\u767d\u6fc3\u5ea6\u4e26\u672a\u5dee\u7570 (12)\u3002\u96d6\u7136\u5728\u901924\u500b\u6708\u8ffd\u8e64\u4e2d\uff0c\u6574\u9ad4\u4ee5\u53ca\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u4e26\u6c92\u6709\u89c0\u5bdf\u5230\u986f\u8457\u5dee\u7570\uff0c\u4f46\u6574\u9ad4\u7d50\u679c\u9084\u662f\u53ef\u4ee5\u770b\u5230Online HDF\u5c0d\u5e74\u9577\u60a3\u8005\u7684\u597d\u8655\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u9019\u500b\u7814\u7a76\u7d71\u8a08\u6548\u529b\u8f03\u4f4e (underpowered)\uff0c\u4e14\u7576\u4e2dESRD\u60a3\u8005\u6b7b\u4ea1\u7387\u5f88\u4f4e\u3002<\/p>\n<p>\u7c21\u800c\u8a00\u4e4b\uff0c\u5169\u500b\u524d\u77bb\u6027RCT\u7814\u7a76(CONTRAST and Turkish HDF studies)\u7684\u6574\u9ad4\u5206\u6790\u7121\u6cd5\u986f\u793a\u51fa\u6574\u9ad4\u6216\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u7684\u512a\u52e2\u3002\u7136\u800c\uff0c\u5169\u500b\u7814\u7a76\u7684\u4e8b\u5f8c\u5206\u6790\u90fd\u53ef\u770b\u51fa\uff0c\u5c0d\u6d41\u5bb9\u91cf\u9ad8 (&gt;23 L\/\u6b21)\u5c0d\u60a3\u8005\u6240\u5e36\u4f86\u7684\u597d\u8655 (3,7)\u3002ESHOL\u7814\u7a76\u9054\u6210\u4e86\u6700\u9ad8\u7684\u5c0d\u6d41\u5bb9\u91cf\uff08\u4e2d\u4f4d\u6578\uff09\uff0c\u9ad8\u5bb9\u91cfHDF\u88ab\u8b49\u5be6\u53ef\u6e1b\u5c1130%\u7684\u6574\u9ad4\u6b7b\u4ea1\u4ee5\u53ca\u5fc3\u8840\u7ba1\u6b7b\u4ea1 (8)\u3002FRENCHIE\u7814\u7a76\u4e3b\u8981\u91dd\u5c0d\u9ad8\u5e74\u9f61\u7684\u60a3\u8005\uff0cHDF\u60a3\u8005\u7d93\u6b77\u8f03\u5c11\u6709\u75c7\u72c0\u7684\u900f\u6790\u4e2d\u4f4e\u8840\u58d3\u8207\u808c\u8089\u62bd\u7b4b\u3002\u96d6\u7136\u5728\u5065\u5eb7\u76f8\u95dc\u7684\u751f\u6d3b\u54c1\u8cea\u3001\u5171\u75c5\u3001\u6b7b\u4ea1\uff0c\u90fd\u6c92\u6709\u5dee\u7570\uff0c\u4f46\u5728\u63a7\u5236\u65b0\u9673\u4ee3\u8b1d\u7684\u9aa8\u982d\u75be\u75c5\u76f8\u95dc\u751f\u7269\u6a19\u8a18\uff0c\u4ee5\u53ca\u03b22-microglobulin\u6578\u503c\u65b9\u9762\uff0cHDF\u7d44\u90fd\u6709\u6539\u5584(12)\u3002\u4ee5\u4e0b\u8868\u683c\u662f\u56db\u500bRCT\u7814\u7a76\u7684\u6574\u7406:<\/p>\n<p>&nbsp;<\/p>\n<table width=\"100%\">\n<tbody>\n<tr>\n<td width=\"86\"><strong>\u96a8\u6a5f\u5c0d\u7167\u8a66\u9a57<\/strong><\/td>\n<td width=\"92\"><strong>\u814e\u81df\u66ff\u4ee3\u7642\u6cd5<\/strong><\/td>\n<td width=\"59\"><strong>\u75c5\u4eba\u6578<\/strong><\/td>\n<td width=\"85\"><strong>\u7814\u7a76\u7d42\u9ede<\/strong><\/td>\n<td width=\"89\"><strong>HDF<\/strong><strong>\u7d44\u7d50\u679c<\/strong><\/td>\n<td width=\"146\"><strong>\u4e8b\u5f8c\u6bd4\u8f03\u6aa2\u5b9a<\/strong><strong> (considering Vcon)<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"86\"><\/td>\n<td width=\"92\"><\/td>\n<td width=\"59\"><\/td>\n<td width=\"85\"><\/td>\n<td width=\"89\"><\/td>\n<td width=\"146\"><\/td>\n<\/tr>\n<tr>\n<td width=\"86\">CONTRAST study\u00a0<sup>3<\/sup><\/td>\n<td width=\"92\">LF-HD \u2b0c olHDFpost<\/td>\n<td width=\"59\">714<\/td>\n<td width=\"85\">Primary end point<br \/>\nall-cause mortality<\/td>\n<td width=\"89\">\u4e3b\u8981\u7d42\u9ede\u6c92\u6709\u986f\u8457\u6548\u76ca<\/td>\n<td width=\"146\">\u7576Vcon &gt; 22 L \/\u6b21\uff0c\u4e3b\u8981\u7d42\u9ede\u6709\u986f\u8457\u6548\u76ca<\/td>\n<\/tr>\n<tr>\n<td width=\"86\"><\/td>\n<td width=\"92\"><\/td>\n<td width=\"59\"><\/td>\n<td width=\"85\"><\/td>\n<td width=\"89\"><\/td>\n<td width=\"146\"><\/td>\n<\/tr>\n<tr>\n<td width=\"86\">Turkish HDF<br \/>\nStudy\u00a0<sup>7<\/sup><\/td>\n<td width=\"92\">HF-HD \u2b0c olHDFpost<\/td>\n<td width=\"59\">782<\/td>\n<td width=\"85\">Primary end point<br \/>\nall-cause mortality and nonfatal CV events<\/td>\n<td width=\"89\">\u4e3b\u8981\u7d42\u9ede\u6c92\u6709\u986f\u8457\u6548\u76ca<\/td>\n<td width=\"146\">\u7576Vcon &gt; 20.5 L \/\u6b21\uff0c\u4e3b\u8981\u7d42\u9ede\u6709\u986f\u8457\u6548\u76ca<\/td>\n<\/tr>\n<tr>\n<td width=\"86\"><\/td>\n<td width=\"92\"><\/td>\n<td width=\"59\"><\/td>\n<td width=\"85\"><\/td>\n<td width=\"89\"><\/td>\n<td width=\"146\"><\/td>\n<\/tr>\n<tr>\n<td width=\"86\">ESHOL<br \/>\nStudy\u00a0<sup>8<\/sup><\/td>\n<td width=\"92\">HF-HD \u2b0c olHDFpost<\/td>\n<td width=\"59\">906<\/td>\n<td width=\"85\">Primary end point<br \/>\nall-cause mortality<\/td>\n<td width=\"89\">\u6e1b\u5c11 30% \u6574\u9ad4\u6b7b\u4ea1\u98a8\u96aa<\/td>\n<td width=\"146\">\u7576Vcon &gt; 25 L \/\u6b21\uff0c\u6e1b\u5c1145% \u6b7b\u4ea1\u98a8\u96aa<\/td>\n<\/tr>\n<tr>\n<td width=\"86\"><\/td>\n<td width=\"92\"><\/td>\n<td width=\"59\"><\/td>\n<td width=\"85\"><\/td>\n<td width=\"89\"><\/td>\n<td width=\"146\"><\/td>\n<\/tr>\n<tr>\n<td width=\"86\">FRENCHIE<br \/>\nStudy\u00a0<sup>12<\/sup><\/td>\n<td width=\"92\">HF-HD \u2b0c olHDFpost<\/td>\n<td width=\"59\">381<\/td>\n<td width=\"85\">Primary endpoint<br \/>\nintradialytic tolerance<br \/>\nSecondary endpoint mortality<\/td>\n<td width=\"89\">\u8f03\u5c11\u7684\u6cbb\u7642\u4e2d\u4f4e\u8840\u58d3\u8207\u808c\u8089\u62bd\u7b4b\uff0c\u5728\u6b21\u7d1a\u7d42\u9ede\u6c92\u6709\u986f\u8457\u5dee\u7570<\/td>\n<td width=\"146\">\u7576Vcon &gt; 20.5 L \/\u6b21\uff0c\u6b21\u8981\u7d42\u9ede\u6c92\u6709\u986f\u8457\u6548\u76ca<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h6 style=\"text-align: left;\">HF, High-Flux; LF, Low-Flux; HD, hemodialysis; HDF, hemodiafiltration: ol-HDF, online hemodiafiltration; Vcon convection volume, CV cardiovascular<br \/>\nCONTRAST Dutch CONvective TRAnsport Study; THDFS Turkish HDF Study; ESHOL Estudio de Super-vivencia de Hemodiafiltraci\u00f3n On-Line; FRENCHIE French Convective HDF Study In Elderly<\/h6>\n<p>&nbsp;<\/p>\n<p>\u6b77\u53f2\u6027\u7684\u7d71\u5408\u5206\u6790\u4ee5\u53ca\/\u6216\u7cfb\u7d71\u6027\u7684\u56de\u9867\uff0c\u767c\u73fe\u6bd4\u8f03HDF\u8207\u6a19\u6e96HD\u6709\u8a31\u591a\u77db\u76fe\u7684\u7d50\u679c (13-15)\u3002\u5f88\u907a\u61be\u7684\u662f\uff0c\u6709\u4e9b\u7d71\u5408\u5206\u6790\u805a\u96c6\u4e86\u591a\u7a2e\u5305\u88dd\u5728\u300c\u5c0d\u6d41\u6cbb\u7642\u300d\u5927\u5098\u4e0b\u7684\u4e0d\u540c\u985e\u578b (\u4f8b\u5982\uff0cHF\u3001acetate-free biofiltration\u3001low volume hemo\u00addiafiltration)\uff0c\u5ffd\u8996\u4f30\u7b97\u5c0d\u6d41\u5bb9\u91cf\u7684\u5f71\u97ff\u6210\u70ba\u9019\u4e9b\u7814\u7a76\u7684\u6700\u5927\u7f3a\u9ede (16,17)\u3002<\/p>\n<p>Nistor \u7b49\u4eba(14)\u5728\u4ed6\u5011\u7684\u7d71\u5408\u5206\u6790\u4e2d\uff0c\u6bd4\u8f03\u4e86\u75c5\u4eba\u5728HDF\u3001HF\u3001acetate-free biofiltration\u4ee5\u53caHD\u7684\u6b7b\u4ea1\u7387\u3002\u4f46\u5206\u6790\u4e2d\u5c0d\u6d41\u6cbb\u7642\u537b\u5305\u542b\u4e86\u4f4e\u5c0d\u6d41\u5bb9\u91cf\u7684\u6cbb\u7642\uff0c\u4f8b\u5982off-line hemofiltration\/hemodiafiltration \u4ee5\u53ca acetate-free biofiltration\u3002\u9019\u4e9b\u985e\u578b\u7684\u5c0d\u6d41\u6cbb\u7642\u5f88\u96e3\u88ab\u6b78\u985e\u70ba\u73fe\u4ee3\u7684\u5c0d\u6d41\u6cbb\u7642\uff0c\u56e0\u5176\u5c0d\u6d41\u5bb9\u91cf\u50c510\u201312 L\/\u6b21\uff0c\u53ea\u76f8\u7576\u65bc\u9ad8\u900f\u91cfHD\u7684\u5167\u90e8\u904e\u6ffe\u7e3d\u91cf\uff0c\u6b64\u6d41\u91cf\u986f\u7136\u6709\u5225\u65bc\u9ad8\u5bb9\u91cfHDF (18,19)\u3002\u53e6\u4e00\u500b\u91dd\u5c0d\u5c0d\u6d41\u5bb9\u91cf\u8207\u6cbb\u7642\u7d50\u679c\u7684\u7d71\u5408\u5206\u6790\uff0c\u767c\u73fe\u8db3\u91cf\u7684HDF\u900f\u6790\u5c0d\u60a3\u8005\u9810\u5f8c\u4e4b\u5f71\u97ff (20)\u3002\u7d9c\u5408\u8cc7\u6599\u986f\u793a\uff0c\u5c0d\u6d41\u900f\u6790\u53ef\u4ee5\u6e1b\u5c11\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u3001\u4f46\u4e0d\u662f\u6574\u9ad4\u6b7b\u4ea1\u7387\uff0c\u800c\u975e\u81f4\u547d\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u8207\u4f4f\u9662\u7684\u5f71\u97ff\u4e26\u4e0d\u78ba\u5b9a\uff0c\u56e0\u70ba\u6b20\u7f3a\u9069\u7576\u7684\u7814\u7a76\u65b9\u6cd5\u8207\u5831\u544a (14)\u3002<\/p>\n<p>\u5e7e\u4e4e\u5728\u6240\u6709\u767c\u8868\u7684\u7814\u7a76(\u5305\u62ec\u89c0\u5bdf\u548c\u4ecb\u5165)\u4e2d\uff0c\u90fd\u6703\u63d0\u53ca\u9054\u6210\u7684\u5c0d\u6d41\u5bb9\u91cf\uff0c\u7121\u8ad6\u5176\u88dc\u5145\u65b9\u5f0f\u70ba\u4f55(\u524d\u7a00\u91cb\u3001\u5f8c\u7a00\u91cb\u3001\u6216\u6df7\u5408)\u3002\u5c0d\u6d41\u5bb9\u91cf\u8207\u60a3\u8005\u6cbb\u7642\u7d50\u679c\u7684\u6539\u5584\u606f\u606f\u76f8\u95dc (21,22)\u3002<\/p>\n<p>\u9019\u500b\u8207\u5c0d\u6d41\u5bb9\u91cf\u6709\u6b63\u5411\u95dc\u806f\u7684\u7d50\u679c\uff0c\u4e5f\u9032\u4e00\u6b65\u88ab\u56db\u500b\u6b50\u6d32RCT\u7814\u7a76\u7684\u500b\u5225\u53d7\u8a66\u8005\u8cc7\u6599\u7d71\u5408\u5206\u6790 (IPD-MA)\u5206\u6790\u8b49\u5be6 (23)\u3002\u7d93\u904e\u8cc7\u6599\u805a\u96c6\uff0c2,793\u500b\u60a3\u8005\u88ab\u7d0d\u5165\u5206\u6790\u4e2d\uff0c\u7d93\u904e\u4e2d\u4f4d\u6578\u70ba2.5\u5e74\u7684\u8ffd\u8e64\uff0c2,793\u500b\u60a3\u8005\u7576\u4e2d769\u4eba\u904e\u4e16\uff0c\u7576\u4e2d292\u540d\u6b7b\u65bc\u5fc3\u8840\u7ba1\u75be\u75c5\u3002HDF\u60a3\u8005\u4f9d\u64da\u63a5\u53d7\u7684\u5c0d\u6d41\u5bb9\u91cf\u88ab\u5206\u70ba\u4e09\u7b49\u4efd\uff0c\u6bd4\u8f03\u6574\u9ad4\u548c\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\uff0c\u4e26\u7528Cox\u6bd4\u4f8b\u98a8\u96aa\u8ff4\u6b78\u6a21\u5f0f\u5206\u6790 (23)\u3002\u5728\u7b2c\u4e00\u500b\u5206\u6790\u4e2d\uff0cOnline HDF\u5728\u6700\u9ad8\u7684\u524d1\/3\u5c0d\u6d41\u5bb9\u91cf\u60a3\u8005\u4e2d\uff0c\u53ef\u4ee5\u770b\u5230\u5b58\u6d3b\u7684\u597d\u8655\uff0c\u4f46\u6548\u76ca\u7d50\u679c\u6703\u56e0\u5c0d\u6d41\u91cf\u8207\u4e0d\u540c\u7684\u9ad4\u578b\u6a19\u6e96\u5316\u65b9\u5f0f\u800c\u6709\u6240\u4e0d\u540c (24)\u3002<\/p>\n<p>\u5728\u524d\u4e09\u5206\u4e4b\u4e00\u7684\u9ad8\u5c0d\u6d41\u5bb9\u91cf\u7d44\u4e2d\uff0c\u5728\u5c0d\u6d41\u5bb9\u7a4d\u6c92\u6709\u6a19\u6e96\u5316\u3001\u6216\u91dd\u5c0d\u8eab\u9ad4\u8868\u9762\u9ad4\u7a4d\u6a19\u6e96\u5316\u3001\u6216\u91dd\u5c0d\u6574\u9ad4\u8eab\u9ad4\u6c34\u5206\u6a19\u6e96\u5316\u6642\uff0c\u6574\u9ad4\u6b7b\u4ea1\u7387\u7686\u53ef\u4ee5\u770b\u5230\u6e1b\u5c11 (hazard ratios (95% confidence intervals of 0.66 (0.52 \u2013 0.83), 0.71 (0.57 \u2013 0.90) and 0.71 (0.57 \u2013 0.89)\uff1b\u800c\u5728\u63a1\u8eab\u9ad4\u9ad4\u91cd\u6216BMI\u6a19\u6e96\u5316\u5f8c\uff0c\u4e26\u6c92\u770b\u5230\u4efb\u4f55\u5dee\u7570\u3002\u9019\u4e9b\u7d50\u679c\u5728\u7b2c\u4e8c\u6b21\u7684\u5206\u6790\u6642\uff0c\u8b49\u5be6online HDF\u6bd4\u8d77HD\uff0c\u53ef\u4ee5\u6e1b\u5c1114%\u7684\u6574\u9ad4\u6b7b\u4ea1\uff0c\u4ee5\u53ca23%\u7684\u5fc3\u8840\u7ba1\u6b7b\u4ea1\uff0c\u800c\u4e14\u6c92\u6709\u8b49\u64da\u986f\u793a\u9810\u5b9a\u7684\u6b21\u7fa4\u9ad4\u5206\u6790\u770b\u5230\u4efb\u4f55\u5dee\u7570\u3002\u5206\u6790\u7d50\u679c\u518d\u6b21\u986f\u793a\uff0c\u6700\u5927\u7684\u5b58\u6d3b\u597d\u8655\u662f\u90a3\u4e9b\u63a5\u53d7\u6700\u9ad8\u7684\u5c0d\u6d41\u5bb9\u91cf (&gt;23 L\/1.73 m<sup>2<\/sup> body surface area) \u7684\u60a3\u8005 (24)\u3002\u5728\u6b7b\u4ea1\u56e0\u7d20\u5225\u5206\u6790\u4e2d\uff0c\u767c\u73feHDF\u53ef\u4ee5\u6709\u6548\u6e1b\u5c11\u81f4\u6b7b\u6027\u5fc3\u81df\u4e8b\u4ef6\uff0c\u5305\u542b\u7f3a\u8840\u6027\u5fc3\u81df\u75c5 (Ischemic heart disease)\u4ee5\u53ca\u9ad4\u6db2\u64c1\u585e(congestion) 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