在连续静脉-静脉血液透析滤过中，20 和 35 ml/kg/h 的中分子清除率。
Middle-molecule clearance at 20 and 35 ml/kg/h in continuous venovenous hemodiafiltration.
机构信息
Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio 44195, USA.
出版信息
Blood Purif. 2010;29(3):259-63. doi: 10.1159/000266483. Epub 2009 Dec 17.
BACKGROUND
Of 5 clinical trials testing dose response of continuous renal replacement therapy (CRRT) in acute kidney injury, 2 showed a benefit, 2 showed none, and 1 appeared equivocal. However, blood-membrane interactions may dominate macromolecule transport in continuous venovenous hemodiafiltration, reducing the impact of dose adjustment. The dosing arms in the Acute Renal Failure Trial Network (ATN) study may have delivered similar clearances for middle molecules.
METHODS
We simulated the 2 CRRT doses in the ATN study using a synthetic polydisperse macromolecular probe in bovine blood. Clearance of tracers between 10 and 100 kDa molecular weight was measured during 6 h of therapy.
RESULTS
Middle-molecule clearance differed by less than 2 ml/min between the 2 dosing arms.
CONCLUSION
The CRRT prescription used in the ATN study appears to have achieved dose separation for small molecules while holding middle-molecule clearance nearly constant. This may explain the outcome difference between the ATN study and earlier studies, and suggests subsequent trial designs.
背景
在 5 项测试急性肾损伤中连续肾脏替代治疗（CRRT）剂量反应的临床试验中，2 项显示出获益，2 项显示无获益，1 项结果不确定。然而，血液-膜相互作用可能在连续性静脉-静脉血液滤过中主导大分子的转运，从而降低剂量调整的影响。急性肾损伤试验网络（ATN）研究中的剂量组可能为中分子提供了相似的清除率。
方法
我们使用牛血液中的合成多分散大分子探针模拟了 ATN 研究中的 2 种 CRRT 剂量。在 6 小时的治疗过程中测量了分子量在 10 到 100 kDa 之间的示踪剂的清除率。
结果
2 个剂量组之间中分子的清除率差异小于 2 ml/min。
结论
ATN 研究中使用的 CRRT 处方似乎在小分子中实现了剂量分离，同时保持了中分子清除率几乎不变。这可能解释了 ATN 研究与早期研究之间的结果差异，并提示了后续的试验设计。
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