Krieter Detlef H, Hunn Elisabeth, Morgenroth Andreas, Lemke Horst-Dieter, Wanner Christoph
Department of Medicine, Division of Nephrology, University of Würzburg, Würzburg, Germany.
Artif Organs. 2008 Dec;32(12):903-9. doi: 10.1111/j.1525-1594.2008.00652.x.
PUREMA H (referred to as PES) is an innovative dialysis membrane for enhanced low-molecular-weight (LMW) protein removal. The purpose of the study was to prove whether its efficacy in hemodialysis (HD) matches that of online hemodiafiltration (HDF) with conventional high-flux membranes. In a prospective, randomized, cross-over study on eight maintenance dialysis patients, treatment efficacy of HD with PES was compared with online postdilution HDF with the two synthetic high-flux membranes polysulfone (referred to as PSU) and Polyamix (referred to as POX). Apart from the infusion of replacement fluid, which was set at 20% of the blood flow rate of 300 mL/min, operating conditions in HD and HDF were kept identical. Small solute and LMW protein plasma clearances as well as the reduction ratio (RR) of cystatin C and retinol-binding protein were not different between the therapies. HDF with POX resulted in a significantly lower myoglobin RR as compared with HD with PES, and HDF with PSU. A 4% higher beta(2)-microglobulin RR was determined in HDF with PSU (73 +/- 5%) as compared with PES in HD (69 +/- 5%). The albumin loss was below 1 g for all treatments. Despite the fact that simple HD did not fully exploit the characteristics of PES, it achieved essentially similar LMW protein removal and albumin loss as compared with online postdilution HDF with the conventional synthetic high-flux membranes PSU and POX. Therefore, HD with PES may have beneficial effects on the outcome of maintenance dialysis patients similar to high-efficiency HDF.
PUREMA H（简称为PES）是一种用于增强低分子量（LMW）蛋白质清除的创新型透析膜。本研究的目的是证明其在血液透析（HD）中的疗效是否与使用传统高通量膜的在线血液透析滤过（HDF）相当。在一项针对8名维持性透析患者的前瞻性、随机、交叉研究中，将使用PES进行HD的治疗效果与使用两种合成高通量膜聚砜（简称为PSU）和聚酰胺（简称为POX）进行在线后置稀释HDF的治疗效果进行了比较。除了将置换液的输注量设定为血流速度300 mL/min的20%外，HD和HDF的操作条件保持相同。各治疗组之间的小分子溶质和LMW蛋白质血浆清除率以及胱抑素C和视黄醇结合蛋白的降低率（RR）并无差异。与使用PES进行HD以及使用PSU进行HDF相比，使用POX进行HDF导致的肌红蛋白RR显著更低。与使用PES进行HD（69±5%）相比，使用PSU进行HDF时测定的β2-微球蛋白RR高4%（73±5%）。所有治疗的白蛋白损失均低于1 g。尽管单纯HD并未充分发挥PES的特性，但与使用传统合成高通量膜PSU和POX进行在线后置稀释HDF相比，其在LMW蛋白质清除和白蛋白损失方面基本相似。因此，使用PES进行HD可能对维持性透析患者的预后产生与高效HDF类似的有益影响。
