Humes H David, Fissell William H, Weitzel William F, Buffington Deborah A, Westover Angela J, MacKay Sherrill M, Gutierrez Jorge M
Department of Medicine, VA Medical Center, and University of Michigan, Ann Arbor, MI 48109-0644, USA.
Am J Kidney Dis. 2002 May;39(5):1078-87. doi: 10.1053/ajkd.2002.32792.
Current renal substitution therapy with hemodialysis or hemofiltration has been an important life-sustaining technology, but it still has suboptimal clinical outcomes in patients with end-stage renal disease or acute renal failure. This therapy replaces the small solute clearance function of the glomerulus but does not replace the metabolic and endocrinologic functions of the tubular cells. This article shows that the combination of a synthetic hemofiltration cartridge and a renal tubule cell assist device (RAD) containing human cells in an extracorporeal circuit replaces filtration, metabolic, and endocrinologic functions in acutely uremic dogs. The RAD maintained excellent performance and durability characteristics for 24 hours of continuous use in the uremic animals. The RAD increased ammonia excretion, glutathione metabolism, and 1,25-dihydroxyvitamin D3 production. Cardiovascular stability in the animals was documented in these studies during this extracorporeal treatment. With these results, clinical evaluation of this device in the treatment of severely ill patients with acute renal failure in an intensive care unit has been initiated.
目前采用血液透析或血液滤过的肾脏替代疗法是一项重要的维持生命的技术，但对于终末期肾病或急性肾衰竭患者，其临床效果仍不尽人意。这种疗法替代了肾小球的小分子溶质清除功能，但并未替代肾小管细胞的代谢和内分泌功能。本文表明，在体外循环中，合成血液滤过器与包含人类细胞的肾小管细胞辅助装置（RAD）相结合，可替代急性尿毒症犬的过滤、代谢和内分泌功能。在尿毒症动物中，RAD连续使用24小时保持了优异的性能和耐用性。RAD增加了氨的排泄、谷胱甘肽代谢以及1,25-二羟维生素D3的生成。在这些研究中，记录了动物在这种体外治疗过程中的心血管稳定性。基于这些结果，已开始在重症监护病房对该装置治疗重症急性肾衰竭患者进行临床评估。
