Meijers Björn K, Weber Viktoria, Bammens Bert, Dehaen Wim, Verbeke Kristin, Falkenhagen Dieter, Evenepoel Pieter
Department of Medicine, Division of Nephrology, University Hospital Leuven, Leuven, Belgium.
Artif Organs. 2008 Mar;32(3):214-9. doi: 10.1111/j.1525-1594.2007.00525.x. Epub 2008 Jan 14.
Removal of protein-bound uremic retention solutes, including p-cresol, by peritoneal dialysis and hemodialysis (HD) is limited. p-Cresol, mainly circulating as sulfate conjugate (p-cresyl sulfate [PCS]), is independently associated with mortality. Fractionated plasma separation and adsorption (FPSA) is a nonbiologic detoxification system for the treatment of liver failure. The FPSA clearance of uremic retention solutes is unknown. We studied PCS clearance by FPSA, using the Prometheus system. The neutral resin adsorbent and the anion exchange adsorbent bind PCS in vitro (reduction ratios [RRs] 37 and 70%). Ex vivo, the adsorbent mass removal (MR) (median 47.5 mg) contributes more than half to total MR (median 89.6 mg). In vivo, PCS RR during FPSA (50%) exceeded the RR during high flux HD (30%). We halted the study after four inclusions due to repeated thrombosis of the arterio-venous conduit. In conclusion, FPSA is a promising technique to improve clearance of protein-bound uremic retention solutes.
通过腹膜透析和血液透析（HD）清除包括对甲酚在内的与蛋白质结合的尿毒症潴留溶质是有限的。对甲酚主要以硫酸盐共轭物（对甲酚硫酸盐[PCS]）的形式循环，其与死亡率独立相关。分级血浆分离吸附（FPSA）是一种用于治疗肝衰竭的非生物解毒系统。FPSA对尿毒症潴留溶质的清除率尚不清楚。我们使用Prometheus系统研究了FPSA对PCS的清除情况。中性树脂吸附剂和阴离子交换吸附剂在体外可结合PCS（还原率[RRs]分别为37%和70%）。在体外，吸附剂的质量清除量（MR）（中位数为47.5 mg）占总MR（中位数为89.6 mg）的一半以上。在体内，FPSA期间的PCS RR（50%）超过了高通量HD期间的RR（30%）。由于动静脉导管反复血栓形成，在纳入4例患者后我们停止了研究。总之，FPSA是一种有前景的技术，可改善对与蛋白质结合的尿毒症潴留溶质的清除。
