Balducci Alessandro, Coen Giorgio, Manni Micaela, Perruzza Italia, Fassino Valeria, Sardella Daniela, Grandi Fabio
Azienda Ospedaliera S. Giovanni Addolorata, Rome, Italy.
Artif Organs. 2004 Dec;28(12):1067-75. doi: 10.1111/j.1525-1594.2004.00001.x.
Different parathyroid hormone (PTH) behavior during hemodialysis with different types of dialysis membranes has been reported. The behavior of intact parathyroid hormone (iPTH) adsorption using different dialysis membranes was assessed in 12 dialysis patients with secondary hyperparathyroidism.
The study was performed according to a longitudinal scheme comprising three treatment modalities, each lasting 2 weeks, for 6 weeks altogether. The first treatment consisted of standard bicarbonate dialysis with low-flux polysulfone, followed by acetate-free biofiltration with high-flux-polysulfone or with polyacrylonitrile-AN69. In the first week of each period, dialysis was delivered by using a 1.3 m(2) surface area and subsequently, a 1.8 m(2) surface area. Intact parathyroid hormone was assayed on the blood and dialysate samples to calculate iPTH adsorption.
The results showed that polyacrylonitrile-AN69 and high-flux polysulfone induce a significantly larger drop in PTH serum levels as compared with low-flux-polysulfone, particularly in the first half of the dialysis session, while the ionized calcium increase is comparable in all different hemodialysis treatments. The measurement of iPTH in the dialysate showed lower values than those disappearing on the blood side, thus suggesting the presence of an adsorptive mechanism in the different dialysis membranes.
High-flux polysulfone is endowed with a comparable adsorptive capacity per surface unit compared to polyacrylonitrile-AN69, although it seems to show a different behavior, as polyacrylonitrile-AN69 saturates early in the first hour of dialysis corresponding to its maximum adsorption power, while high-flux-polysulfone displays a more lasting adsorptive capacity. Thus, iPTH changes during hemodialysis also depend on dialyzer characteristics and the dialysis membrane adsorption.
已有报道称,在使用不同类型透析膜进行血液透析期间,甲状旁腺激素(PTH)的行为有所不同。本研究评估了12例继发性甲状旁腺功能亢进的透析患者使用不同透析膜时,完整甲状旁腺激素(iPTH)的吸附行为。
本研究按照纵向方案进行,包括三种治疗方式,每种方式持续2周,共6周。第一种治疗方式为使用低通量聚砜进行标准碳酸氢盐透析,随后采用无醋酸盐生物滤过,使用高通量聚砜或聚丙烯腈-AN69。在每个阶段的第一周,使用1.3 m²表面积的透析器进行透析,随后使用1.8 m²表面积的透析器。对血液和透析液样本进行完整甲状旁腺激素检测,以计算iPTH吸附量。
结果显示,与低通量聚砜相比,聚丙烯腈-AN69和高通量聚砜能使血清PTH水平显著下降,尤其是在透析过程的前半段,而在所有不同的血液透析治疗中,离子钙的增加情况相当。透析液中iPTH的测量值低于血液侧消失的值,这表明不同透析膜中存在吸附机制。
与聚丙烯腈-AN69相比,高通量聚砜每单位表面积具有相当的吸附能力,尽管其行为似乎有所不同,因为聚丙烯腈-AN69在透析的第一小时早期就达到饱和,对应其最大吸附能力,而高通量聚砜则表现出更持久的吸附能力。因此,血液透析期间iPTH的变化也取决于透析器特性和透析膜吸附情况。