Ragazzoni E, Carpani P, Agliata S, Ciranna G, Cusinato S, Albini M, Cavagnino A
U.O. Aziendale di Nefrologia e Dialisi, Ospedale di Borgomanero, Borgomanero, Novara.
G Ital Nefrol. 2004 Nov-Dec;21 Suppl 30:S85-90.
The high convection dialytic techniques, such as hemodiafiltration (HDF), can cause the loss of important molecules such as growth factors, vitamins and amino acids. Hemodiafiltration reinfusion (HFR) is an HDF on-line process, using a sipping cartridge, able to remove uremic toxins and give back a "repaired" ultra-filtrate to the patient. We aimed to establish the plasmatic amino acid levels before and after dialysis in HFR vs. HDF on-line, with scrupulous attention to branched chain amino acids (BCAA) such as isoleucine, leucine and valine. These amino acids, often present with low plasmatic levels in hemodialyzed patients, seem to be related to a picture of malnourishment.
Eleven male patients on bicarbonate dialysis, for at least 1 yr, were evaluated (average dialytic age = 88 months, /average age = 67 yrs), with good dialytic efficiency and body mass levels, randomized in HFR or HDF on-line (filter PAN AN 69) for 1 week of treatment, respectively. The different results of each method were controlled for the same patient. Blood samples were taken before and after dialysis in each 2nd hemodialytic weekly session. Total amino acids, essential, non-essential and BCAA were determined by gas-chromatography.
There was no difference detected in pre-dialytic plasmatic levels of analyzed amino acids between the two groups. In post-dialysis, HDF patients demonstrated a total essential, non-essential amino acid and BCAA higher loss rate, compared to HFR patients. Post-dialysis amino acid level averages were: total amino acids in HDF 1852 +/- 302.6 micromol/L, in HFR 2395 +/- 492.8 micromol/L (p = 0.018); essential amino acids in HDF 428.8 +/- 118.2 micromol/L, in HFR 510.3 +/- 129.3 micromol/L (p = 0.022); non-essential amino acids in HDF 1176 +/- 213 micromol/L, in HFR 1546 +/- 339.2 micromol/L (p = 0.01); BCAA in HDF 242.7 +/- 83.42 micromol/L, and in HFR 286.7 +/- 89.9 micromol/L (p = 0.03).
Since low plasmatic BCAA levels are related to anorexia and malnourishment, the loss of these amino acids can be important in the dialytic technique choice. HFR can offer an outstanding advantage, combining a high convection treatment with medium molecule removal, without compromising physiologic molecule loss.
高对流透析技术，如血液透析滤过（HDF），可导致生长因子、维生素和氨基酸等重要分子的丢失。血液透析滤过再输注（HFR）是一种在线HDF过程，使用一个啜吸滤芯，能够清除尿毒症毒素并将“修复”后的超滤液回输给患者。我们旨在确定HFR与在线HDF透析前后的血浆氨基酸水平，尤其关注支链氨基酸（BCAA），如异亮氨酸、亮氨酸和缬氨酸。这些氨基酸在血液透析患者中血浆水平通常较低，似乎与营养不良状况有关。
对11名接受碳酸氢盐透析至少1年的男性患者进行评估（平均透析龄 = 88个月，平均年龄 = 67岁），其透析效率和体重水平良好，随机分为HFR组或在线HDF组（滤器PAN AN 69），分别进行1周的治疗。对同一患者的每种方法的不同结果进行对照。在每周第二次血液透析治疗前后采集血样。通过气相色谱法测定总氨基酸、必需氨基酸、非必需氨基酸和BCAA。
两组间透析前分析的氨基酸血浆水平未检测到差异。透析后，与HFR患者相比，HDF患者的必需氨基酸、非必需氨基酸和BCAA的总丢失率更高。透析后氨基酸水平平均值分别为：HDF组总氨基酸为1852±302.6微摩尔/升，HFR组为2395±492.8微摩尔/升（p = 0.018）；HDF组必需氨基酸为428.8±118.2微摩尔/升，HFR组为510.3±129.3微摩尔/升（p = 0.022）；HDF组非必需氨基酸为1176±213微摩尔/升，HFR组为1546±339.2微摩尔/升（p = 0.01）；HDF组BCAA为242.7±83.42微摩尔/升，HFR组为286.7±89.9微摩尔/升（p = 0.03）。
由于血浆BCAA水平低与厌食和营养不良有关，这些氨基酸的丢失在透析技术选择中可能很重要。HFR可以提供显著优势，将高对流治疗与中分子清除相结合，而不影响生理分子的丢失。
