Man N K, Chauveau P, Kuno T, Poignet J L, Yanai M
Department of Nephrology, Necker Hospital, Paris, France.
ASAIO Trans. 1991 Jul-Sep;37(3):M463-5.
Kinetics of phosphate removal, based on hourly collection of used dialysate or filtrate and hourly changes of phosphate plasma concentration, were studied in hemodialysis (QB 300; QD 500 ml/min), hemodiafiltration (QB 300; QD 500; QSF 25 ml/min), and hemofiltration (QB 250; QSF 70 ml/min) for six 5-hour sessions in each mode of therapy. Whatever the pretreatment phosphate concentration (1.5-2.0 mmol/L range), and whatever the treatment modality used, final plasma phosphate concentration was in the narrow range of 0.8-0.9 mmol/L, and about 50% of the total mass transfer occurred during the first 2 hours. At the third hour, a steady state is reached, suggesting that removal of phosphate is limited by the rate of phosphate transfer from body compartments to extracellular fluid, which was on the average about 362 mumol/kg.hr. Consequently, total phosphate mass transfer accounts only for 20 to 28 mmol per session. Control of pretreatment phosphatemia in the range of 1.5 to 2.0 mmol/L depends on daily phosphate binder prescription, calcitriol supplementation, and control of metabolic acidosis; one cannot rely on intermittent phosphate removal during the dialysis session.
基于每小时收集的用过的透析液或滤液以及血浆磷酸盐浓度的每小时变化，在血液透析（血流量QB 300；透析液流量QD 500 ml/分钟）、血液透析滤过（血流量QB 300；透析液流量QD 500；置换液流量QSF 25 ml/分钟）和血液滤过（血流量QB 250；置换液流量QSF 70 ml/分钟）中，对每种治疗模式进行了六个5小时疗程的磷酸盐清除动力学研究。无论预处理磷酸盐浓度如何（在1.5 - 2.0 mmol/L范围内），也无论使用何种治疗方式，最终血浆磷酸盐浓度都在0.8 - 0.9 mmol/L的狭窄范围内，并且约50%的总质量转移发生在前2小时。在第三小时，达到稳定状态，这表明磷酸盐的清除受磷酸盐从身体各部位转移到细胞外液的速率限制，该速率平均约为362 μmol/kg·小时。因此，每次疗程的总磷酸盐质量转移仅为20至28 mmol。将预处理血磷水平控制在1.5至2.0 mmol/L范围内取决于每日磷酸盐结合剂的处方、骨化三醇的补充以及代谢性酸中毒的控制；不能仅仅依靠透析过程中间歇性的磷酸盐清除。
