Matsuhashi Naoki, Yoshioka Tetsushiro
Nephrology Unit, Manda Memorial Hospital Diabetes Center, Sapporo, Japan.
Nephron. 2002;92(3):601-4. doi: 10.1159/000064087.
BACKGROUND/AIMS: Inflammatory process induced by endotoxin is one of the causes of resistance to recombinant human erythropoietin (rHuEPO) in hemodialysis patients. Thus dialysate contaminated with endotoxin may diminish response to rHuEPO. We investigated whether dose of rHuEPO could be reduced with endotoxin-free ultrafiltered dialysate.
Twenty-seven chronic hemodialysis patients receiving rHuEPO were studied. The patients did not have known causes of anemia other than chronic renal failure. An endotoxin-cut polyethylene ultrafilter was installed into the dialysate fluid circuit. Hematocrit and dose of rHuEPO were monitored before and after installation. Dose of rHuEPO was adjusted to keep hematocrit at about 30%. Endotoxin concentration of dialysate was measured by commercial limulus test (Endospecy.
After installation of ultrafilter, dialysate endotoxin concentration decreased from >100 to <1.0 endotoxin units/liter (EU/l). Dose of rHuEPO decreased from 90.0 U/kg/week (median) to 57.3 U/kg/week (p < 0.05) and hematocrit increased from 30.3% (median) to 32.2% (p = 0.03) after 5 months of installation of ultrafilter. The running cost of the ultrafilter corresponded to only 4% of the cost of spared rHuEPO.
Ultrafiltered endotoxin-free dialysate caused significant reduction in dose of rHuEPO to keep target hematocrit level. Endotoxin-cut ultrafilter was beneficial to hemodialysis patients in medical and in economical aspects.
背景/目的：内毒素诱导的炎症过程是血液透析患者对重组人促红细胞生成素（rHuEPO）产生抵抗的原因之一。因此，被内毒素污染的透析液可能会降低对rHuEPO的反应。我们研究了使用无内毒素的超滤透析液是否可以降低rHuEPO的剂量。
对27名接受rHuEPO治疗的慢性血液透析患者进行了研究。除慢性肾衰竭外，这些患者没有已知的贫血原因。在透析液回路中安装了一种内毒素截留聚乙烯超滤器。在安装前后监测血细胞比容和rHuEPO的剂量。调整rHuEPO的剂量以将血细胞比容保持在约30%。通过商业鲎试剂检测（Endospecy）测量透析液的内毒素浓度。
安装超滤器后，透析液内毒素浓度从>100内毒素单位/升（EU/l）降至<1.0 EU/l。安装超滤器5个月后，rHuEPO的剂量从90.0 U/kg/周（中位数）降至57.3 U/kg/周（p<0.05），血细胞比容从30.3%（中位数）升至32.2%（p = 0.03）。超滤器的运行成本仅相当于节省的rHuEPO成本的4%。
超滤无内毒素透析液可显著降低rHuEPO的剂量以维持目标血细胞比容水平。内毒素截留超滤器在医学和经济方面对血液透析患者均有益。
