Chan Christopher T, Liu Peter P, Arab Sara, Jamal Nazir, Messner Hans A
Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Am Soc Nephrol. 2009 Mar;20(3):665-71. doi: 10.1681/ASN.2008050498. Epub 2008 Dec 17.
Nocturnal home hemodialysis (NHD) is associated with an increase in hemoglobin level. We hypothesized that NHD enhances the removal of toxins of hematopoietic progenitor cells (HPCs), thereby improving HPC growth and function. Among 16 patients with ESRD, 2 mo of NHD nearly doubled Kt/V per session and significantly lowered both parathyroid hormone levels and serum phosphate concentration. In addition, treatment with NHD improved hemoglobin levels from 113 +/- 3 to 125 +/- 4 g/L (P = 0.03) without altering erythropoietin requirements or iron status. To assess whether NHD may enhance removal of HPC toxins, we collected paired plasma samples from the same patient during treatment with conventional HD and NHD. In vitro, growth of erythroid (BFU-E) and granulocytic (CFU-GM) colonies was superior when cultured with NHD plasma compared with conventional HD plasma. Differential gene expression profiles obtained from peripheral blood and HPC colonies revealed similar upregulation of genes responsible for HPC mobilization and growth and production of red blood cells. In conclusion, the enhanced clearance by NHD is associated with an improvement in HPC growth and a coordinated increase in expression of genes relevant to production of red blood cells.
夜间家庭血液透析（NHD）与血红蛋白水平升高有关。我们推测，NHD可增强对造血祖细胞（HPC）毒素的清除，从而改善HPC的生长和功能。在16例终末期肾病（ESRD）患者中，2个月的NHD使每次治疗的Kt/V几乎增加了一倍，并显著降低了甲状旁腺激素水平和血清磷酸盐浓度。此外，NHD治疗使血红蛋白水平从113±3g/L提高到125±4g/L（P = 0.03），而不改变促红细胞生成素的需求或铁状态。为了评估NHD是否可增强对HPC毒素的清除，我们在常规血液透析（HD）和NHD治疗期间从同一患者采集了配对的血浆样本。在体外，与常规HD血浆相比，用NHD血浆培养时红系集落（BFU-E）和粒系集落（CFU-GM）的生长更好。从外周血和HPC集落获得的差异基因表达谱显示，负责HPC动员、生长和红细胞生成的基因有类似的上调。总之，NHD增强的清除作用与HPC生长的改善以及与红细胞生成相关基因表达的协同增加有关。
