Davenport Andrew, Gura Victor, Ronco Claudio, Beizai Masoud, Ezon Carlos, Rambod Edmond
Centre for Nephrology, Division of Medicine, Royal Free and University College Hospital Medical School, London, UK.
Lancet. 2007 Dec 15;370(9604):2005-10. doi: 10.1016/S0140-6736(07)61864-9.
More frequent haemodialysis can improve both survival and quality of life of patients with chronic kidney disease. However, there is little capacity in the UK to allow patients to have more frequent haemodialysis treatments in hospital and satellite haemodialysis units. New means of delivering haemodialysis are therefore required. Our aim was to assess the safety and efficiency of a wearable haemodialysis device.
Eight patients with end-stage kidney failure (five men, three women, mean age 51.7 [SD 13.8] years) who were established on regular haemodialysis were fitted with a wearable haemodialysis device for 4-8 h. Patients were given unfractionated heparin for anticoagulation, as they would be for standard haemodialysis.
There were no important cardiovascular changes and no adverse changes in serum electrolytes or acid-base balance. There was no evidence of clinically significant haemolysis in any patient. Mean blood flow was 58.6 (SD 11.7) mL/min, with a dialysate flow of 47.1 (7.8) mL/min. The mean plasma urea clearance rate was 22.7 (5.2) mL/min and the mean plasma creatinine clearance rate was 20.7 (4.8) mL/min. Clotting of the vascular access occurred in two patients when the dose of heparin was decreased and the partial thromboplastin time returned towards the normal reference range in both of these patients. The fistula needle became dislodged in one patient, but safety mechanisms prevented blood loss, the needle was replaced, and treatment continued.
This wearable haemodialysis device shows promising safety and efficacy results, although further studies will be necessary to confirm these results.
更频繁的血液透析可改善慢性肾病患者的生存率和生活质量。然而，英国医院和卫星血液透析单位让患者进行更频繁血液透析治疗的能力有限。因此，需要新的血液透析治疗方式。我们的目的是评估一种可穿戴式血液透析设备的安全性和有效性。
8例接受常规血液透析的终末期肾衰竭患者（5例男性，3例女性，平均年龄51.7[标准差13.8]岁）佩戴可穿戴式血液透析设备4 - 8小时。患者接受普通肝素抗凝，与标准血液透析时相同。
未出现重要的心血管变化，血清电解质或酸碱平衡也未出现不良变化。没有任何患者出现具有临床意义的溶血迹象。平均血流量为58.6（标准差11.7）毫升/分钟，透析液流量为47.1（7.8）毫升/分钟。平均血浆尿素清除率为22.7（5.2）毫升/分钟，平均血浆肌酐清除率为20.7（4.8）毫升/分钟。当肝素剂量减少且这两名患者的部分凝血活酶时间恢复至正常参考范围时，两名患者的血管通路发生凝血。一名患者的内瘘穿刺针移位，但安全装置防止了失血，更换了穿刺针并继续治疗。
这种可穿戴式血液透析设备显示出了有前景的安全性和有效性结果，不过仍需进一步研究来证实这些结果。
