Abe M, Okada K, Maruyama T, Inoshita A, Ikeda K, Uto E, Kikuchi F, Matsumoto K
Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo.
Int J Artif Organs. 2008 Oct;31(10):898-904. doi: 10.1177/039139880803101006.
Changes in plasma immunoreactive insulin (IRI) and connecting-peptide immunoreactivity (CPR) concentrations during hemodialysis (HD) were evaluated in diabetic HD patients with 3 different high-flux membranes. The removal properties of the membranes were compared.
In this prospective controlled study, 15 stable diabetic patients on HD were randomly selected for 6 HD sessions with 3 different membranes: polysulfone (PS), cellulose triacetate (CTA), and polymethylmethacrylate (PMMA). Blood samples were obtained from the blood tubing at the arterial (A) site at the beginning and end of the sixth HD session. At 60 minutes after dialysis initiation, blood samples were obtained from both the A and venous (V) sites of the dialyzer to investigate the clearance and removal properties of the membranes.
The plasma IRI and CPR levels decreased significantly at each time point with all 3 membranes. IRI clearance with the PS membrane was significantly higher than that with the CTA and PMMA membranes. No difference was observed in the IRI reduction rate between the 3 membranes. CPR clearance and reduction rate with the PMMA membrane were lower than with the PS and CTA membranes. No significant difference was observed in serum creatinine clearance and reduction rates between the 3 membranes; however, serum urea nitrogen clearance was significantly lower with the PMMA membrane compared with the PS and CTA membranes. A significantly high beta2-microglobulin clearance and reduction rate was achieved in the order PS > CTA > PMMA.
Plasma IRI and CPR are cleared by HD; their clearance rates differ with the dialyzer membranes. Plasma IRI clearance with the PS membrane is higher than that with the CTA and PMMA membranes.
在使用3种不同高通量膜进行血液透析（HD）的糖尿病HD患者中，评估血液透析期间血浆免疫反应性胰岛素（IRI）和连接肽免疫反应性（CPR）浓度的变化。比较这些膜的清除特性。
在这项前瞻性对照研究中，随机选择15例接受HD的稳定糖尿病患者，使用3种不同的膜进行6次HD治疗：聚砜（PS）、三醋酸纤维素（CTA）和聚甲基丙烯酸甲酯（PMMA）。在第6次HD治疗开始和结束时，从动脉（A）部位的血路管中采集血样。在透析开始60分钟后，从透析器的A和静脉（V）部位采集血样，以研究膜的清除率和清除特性。
使用所有3种膜时，每个时间点的血浆IRI和CPR水平均显著下降。PS膜的IRI清除率显著高于CTA膜和PMMA膜。3种膜之间的IRI降低率未观察到差异。PMMA膜的CPR清除率和降低率低于PS膜和CTA膜。3种膜之间的血清肌酐清除率和降低率未观察到显著差异；然而，与PS膜和CTA膜相比，PMMA膜的血清尿素氮清除率显著较低。PS＞CTA＞PMMA顺序下，β2-微球蛋白清除率和降低率显著较高。
HD可清除血浆IRI和CPR；它们的清除率因透析器膜而异。PS膜的血浆IRI清除率高于CTA膜和PMMA膜。
