nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2021-1-32-48nid-6Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESИстория и современное состояние методик гемодиализа и гемодиафильтрации. Обзор литературыCurrent state of hemodialysis and hemodiafiltration. ReviewЗаряЯ. В.ZaryaY. V.yana.zarya@fmc-ag.comГуревичК. Я.GurevichK. Ya.noemail@neicon.ruООО «Центр Диализа Санкт-Петербург»Россия«International Dialysis Center Saint-Petersburg»Russian Federation«FRESENIUS MEDICAL CARE»Россия«FRESENIUS MEDICAL CARE»Russian Federation2021210620242313248Copyright © Заря Я.В., Гуревич К.Я., 20242024Заря Я.В., Гуревич К.Я.Zarya Y.V., Gurevich K.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/6

Более 850 млн человек в мире страдает различной патологией почек, потенциально необратимой и приводящей к терминальной почечной недостаточности и инвалидизации населения. По-прежнему, основным методом лечения является замещение утраченной функции почек специализированными методами лечения: гемодиализ, перитонеальный диализ, гемодиафильтрация и транасплантация почки. Количество трансплантаций донорской почки остается низким, что определяет диализ как основной метод лечения почечной недостаточности. Около 80% пациентов с терминальной стадией почечной недостаточности находятся на лечении программным гемодиализом. В обзоре кратко представлена история развития методов внепочечного (экстракорпорального) очищения крови организма, эволюция технического оборудования и методологий, изменение представлений о существующих методах по мере накопления доказательной базы. В статье рассмотрены показания и противопоказания к тем или иным методам лечения почечной недостаточности. Приводится сравнительный анализ и прослеживается путь развития разнообразных диализных методик (гемодиализ интермиттирующий низкопоточный, интермиттирующий высокопоточный, гемодиализ интермиттирующий продленный/продолжительный, гемодиафильтрация интермиттирующая/продленная). В настоящее время наиболее эффективной методикой диализа является гемодиафильтрация вследствие комбинации диффузионного и конвективного транспорта растворенных веществ через мембрану гемофильтра. В статье освещены преимущества метода гемодиафильтрации перед гемодиализом (лучшее выведение уремических токсинов, влияние на липидный спектр крови, лучший контроль анемии, снижение доз рЭПО, лучшая биосовместимость и гемодинамическая стабильность, уменьшение воспаления и продуктов оксидативного стресса), обзор ранее существовавших и недавно проведенных крупных рандомизированных исследований. Рассматривается гемодиафильтрация как наиболее эффективный метод диализа, ассоциированный с лучшей выживаемостью пациентов. Оцениваются современные критерии (международные стандарты) для онлайн-гемодиафильтрации (ГДФ OL). В статье обсуждаются факторы, ограничивающие применение ГДФ OL в клинической практике. Приводятся последние данные по разработке и результатам первых клинических исследований использования расширенного диализа с использованием мембран со «средней точкой отсечения». Обсуждается возможность применения расширенного диализа в качестве альтернативы ГДФ OL.

More than 850 million people worldwide suffer from various kidney diseases that are potentially irreversible and lead to end-stage kidney failure and disability. As before, the main method of treatment is to replace the lost kidney function with specialized methods of treatment: hemodialysis, peritoneal dialysis, hemodiafiltration and kidney transplantation. The number of available donor kidney transplants remains low. So dialysis remains the main method of treating kidney failure. About 80% of patients with the end-stage renal failure are treated with chronic programmed hemodialysis. The review briefly presents the history of the development of methods of extrarenal (extracorporeal) purification of the body's blood, the evolution of technical equipment and methodologies, and the change in ideas about existing methods as the evidence base accumulates. The article discusses the indications and contraindications of various methods of treatment of kidney failure. A comparative analysis is given and the path of development of various dialysis techniques is traced (low-flow intermittent hemodialysis, high-flow intermittent hemodialysis, extended/long-term intermittent hemodialysis, intermittent/extended hemodiafiltration). Currently, the most effective method of dialysis is hemodiafiltration as a result of a combination of diffusive and convective transport of solutes through the hemofilter membrane. The review considers the advantages of the hemodiafiltration method for hemodialysis (better elimination of uremic toxins, the effect on the blood lipid spectrum, better control of anemia, reduced doses of rEPO, better biocompatibility and hemodynamic stability, reduction of inflammation and oxidative stress products), a review of previously existing and recently conducted large randomized studies. Hemodiafiltration is considered to be the most effective method of dialysis associated with better patient survival. Modern criteria (international standards) for online hemodiafiltration (HDF OL) are evaluated. The article discusses the factors limiting the use of HDF OL in clinical practice. The latest data on the development and results of the first clinical studies of the use of extended dialysis using membranes with a "mid-cut-off point" is presented. The possibility of using extended dialysis as an alternative to HDF OL is discussed.

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The authors declare that there are no conflicts of interest present.