高通量与高截留透析膜的前瞻性、随机、双盲、交叉研究

A pilot, randomized, double-blind, cross-over study of high cut-off versus high-flux dialysis membranes.

机构信息

Department of Nephrology, Austin Hospital, University of Melbourne, Melbourne, Vic., Australia.

出版信息

Blood Purif. 2009;28(4):365-72. doi: 10.1159/000235961. Epub 2009 Sep 3.

DOI:10.1159/000235961

PMID:19729908

Abstract

BACKGROUND

High cut-off (HCO) membranes may increase beta(2)-microglobulin (beta2M) removal compared to standard high-flux membranes.

METHODS

Eight stable haemodialysis patients were enrolled in a prospective, randomized, double-blind, cross-over study and treated with HCO and high-flux membranes for 2 weeks each, between a 1-week washout period. Primary end point was serum beta2M removal. Secondary end points included serum albumin concentrations, albumin and small solute clearances.

RESULTS

HCO membranes achieved significantly lower median post-dialysis beta2M concentration (10.8 vs. 14.2 mg/l; p = 0.003) and greater beta2M reduction ratio (62.3 vs. 51.0%; p < 0.002). Serum albumin decreased with HCO membranes (from 36 to 29.5 g/l; p = 0.018) but increased to 33.5 g/l after the washout period. Albumin clearance was significantly greater with HCO membranes (2.2 vs. 0.06 ml/min; p = 0.004). Urea reduction ratio was significantly lower with HCO membranes (64.8 vs. 71.5%; p < 0.001).

CONCLUSION

beta2M removal was superior with HCO membranes. Reduction in serum albumin and lower small solute clearance require further investigations.

摘要

背景

高通量（HCO）膜与标准高通量膜相比，可能会增加β2-微球蛋白（β2M）的清除率。

方法

8 名稳定的血液透析患者参与了一项前瞻性、随机、双盲、交叉研究，分别接受 HCO 和高通量膜治疗 2 周，期间有 1 周的洗脱期。主要终点是血清β2M 的清除率。次要终点包括血清白蛋白浓度、白蛋白和小分子清除率。

结果

HCO 膜显著降低了中位透析后β2M 浓度（10.8 与 14.2mg/l；p=0.003）和更大的β2M 降低率（62.3 与 51.0%；p<0.002）。血清白蛋白随 HCO 膜而下降（从 36 降至 29.5g/l；p=0.018），但在洗脱期后增加至 33.5g/l。HCO 膜的白蛋白清除率显著增加（2.2 与 0.06ml/min；p=0.004）。HCO 膜的尿素降低率显著降低（64.8 与 71.5%；p<0.001）。