Van Biesen Wim, Eloot Sunny, Verleysen Annick, Glorieux Griet, Veys Nic, Vanholder Raymond, Lameire Norbert
Renal Division, Department of Internal Medicine, University Hospital Ghent, 9000 Ghent, Belgium.
Nephrol Dial Transplant. 2006 Apr;21(4):1069-72. doi: 10.1093/ndt/gfk038. Epub 2006 Jan 12.
The Genius dialysis system is advocated as a tool to perform slow extended daily dialysis (SLEDD) in patients with acute renal failure at the intensive care unit. At low blood flows however, it is sometimes problematic to maintain sufficient systemic pressure in the dialysate circuit, a problem that can be overcome by clamping the dialysate outflow line. This intervention can however decrease the flow in the dialysate circuit, and can thus potentially decrease the clearance. This article analyses the impact of this intervention on the blood and dialysate flows and on the removal of retention products.
The study was done in 20 stable chronic dialysis patients to avoid additional bias caused by changing comorbidities in ICU patients. Patients were treated by Genius, once with clamping and once without clamping, cross-over in a randomized fashion, and with 1 week interval. Flows in the dialysate and blood circuit were measured with a transsonic flow probe. Urea, creatinine, Beta 2 microglobulin and phosphate were measured in the dialysate, and in the serum before and after dialysis.
There was no clinically significant difference in blood or dialysate flows, nor in clearance or removal of retention products during the sessions with or without clamping.
The technique of using clamping of the dialysate outflow line in the Genius system to increase systemic pressure, when the system is used in SLEDD, is a safe technique which does not alter the clearances.
Genius透析系统被推荐作为在重症监护病房对急性肾衰竭患者进行缓慢延长每日透析（SLEDD）的工具。然而，在低血流量时，有时难以在透析液回路中维持足够的系统压力，这个问题可通过夹住透析液流出管路来克服。然而，这种干预会降低透析液回路中的流量，从而可能降低清除率。本文分析了这种干预对血液和透析液流量以及潴留产物清除的影响。
该研究在20例稳定的慢性透析患者中进行，以避免因重症监护病房患者合并症变化引起的额外偏倚。患者使用Genius进行治疗，一次夹住流出管路，一次不夹，以随机方式交叉进行，间隔1周。用超声流量探头测量透析液和血液回路中的流量。在透析液以及透析前后的血清中测量尿素、肌酐、β2微球蛋白和磷酸盐。
夹闭与未夹闭期间，血液或透析液流量、清除率或潴留产物清除方面均无临床显著差异。
在SLEDD中使用Genius系统时，通过夹住透析液流出管路来增加系统压力的技术是一种安全的技术，不会改变清除率。
