Nakashima Ayumu, Ogata Satoshi, Doi Shigehiro, Yamahira Michihiro, Naraki Satoe, Takasugi Norihisa, Ohmoto Toshifumi, Ito Takafumi, Masaki Takao, Yorioka Noriaki
Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, and Department of Internal Medicine, Sanyo Hospital, Fukuyama, Japan.
Clin Exp Nephrol. 2006 Sep;10(3):210-5. doi: 10.1007/s10157-006-0431-x.
It is important to observe the flow pattern of dialysate when evaluating dialyzer function and developing the most appropriate design. We investigated dialysate flow through two polysulfone membrane dialyzers (TS-UL [Toray Medical] and APS-S [Asahi Medical]) by computed tomography (CT), with barium sulfate as the contrast medium. We also performed a clinical comparison of these two dialyzers.
For the in vitro experiment, after confirming the steady-state flow of mock blood (xanthan gum solution; 200 ml/min) and dialysate (500 ml/min), fresh dialysate, containing 5% (w/v) barium sulfate was perfused, and longitudinal CT scans of the dialyzer were obtained. Then the concentration of barium sulfate was measured (in Hounsfield units) in three fixed regions of interest. For the in vivo experiment, 12 patients on stable hemodialysis who had been using the APS-S for more than 1 month were switched to the TS-UL for 1 month and changes in various parameters were assessed.
The distribution of dialysate was homogeneous on CT scans of the TS-UL, but not on scans of the APS-S. The dialysate concentration curves for the three regions of interest were similar with the TS-UL, but not with the APS-S. Clearance of urea nitrogen and albumin loss were both significantly higher with the TS-UL than with the APS-S. The decrease in alpha 1-microglobulin was larger with the TS-UL than with the APS-S, but not significantly.
Clearance of substances over a wide range of molecular weights was higher with the TS-UL than with the APS-S, and differences in the design of the dialysate compartment may have been involved in this feature.
在评估透析器功能和制定最合适的设计时，观察透析液的流动模式很重要。我们通过计算机断层扫描（CT），以硫酸钡作为造影剂，研究了透析液在两种聚砜膜透析器（TS - UL[东丽医疗]和APS - S[旭化成医疗]）中的流动情况。我们还对这两种透析器进行了临床比较。
在体外实验中，确认模拟血液（黄原胶溶液；200毫升/分钟）和透析液（500毫升/分钟）的稳态流动后，灌注含有5%（重量/体积）硫酸钡的新鲜透析液，并对透析器进行纵向CT扫描。然后在三个固定的感兴趣区域测量硫酸钡的浓度（以亨氏单位计）。在体内实验中，将12名稳定血液透析且使用APS - S超过1个月的患者改用TS - UL透析1个月，并评估各种参数的变化。
TS - UL的CT扫描显示透析液分布均匀，而APS - S的扫描结果并非如此。TS - UL三个感兴趣区域的透析液浓度曲线相似，而APS - S则不然。TS - UL的尿素氮清除率和白蛋白丢失均显著高于APS - S。TS - UL使α1 - 微球蛋白的降低幅度大于APS - S，但差异不显著。
TS - UL对广泛分子量物质的清除率高于APS - S，透析液腔室设计的差异可能与这一特性有关。
