Su Winnie S, Lekas Poli, Carlisle Euan J, Cowin Richard, Bellamy James, Margetts Peter J, Brimble Kenneth Scott, Clase Catherine M, Gangji Azim S
Division of Nephrology, McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Hemodial Int. 2011 Apr;15(2):219-25. doi: 10.1111/j.1542-4758.2011.00533.x. Epub 2011 Mar 13.
Hypophosphatemia is observed in patients undergoing nocturnal hemodialysis. Phosphate is commonly added to the dialysate acid bath, but systematic evaluation of the safety and reliability of this strategy is lacking. The objectives of this study were 4-fold. First, we determined whether predictable final dialysate phosphate concentrations could be achieved by adding varying amounts of Fleet® enema. Second, we assessed the stability of calcium (Ca) and phosphate dialysate levels under simulated nocturnal hemodialysis conditions. Third, we assessed for Ca-phosphate precipitate. Finally, we evaluated whether dialysate containing Fleet® enema met the current sterility standards. We added serial aliquots of enema to 4.5 L of dialysate acid concentrate and proportioned the solution on Gambro and Althin/Baxter dialysis machines for up to 8 hours. We measured dialysate phosphate, Ca, pH, and bicarbonate concentrations at baseline, and after simulated dialysis at 4 and 8 hours. We evaluated for precipitation visually and by assessing optical density at 620 nm. We used inoculation of agar to detect bacteria and Pyrotell reaction for endotoxin. For every 30 mL of Fleet® (1.38 mmol/mL of phosphate) enema added, the dialysate phosphate concentration increased by 0.2 mmol/L. There were no significant changes in dialysate phosphate, Ca, pH, and bicarbonate concentrations over 8 hours. No precipitate was observed in the dialysate by optical density measures at 620 nm for additions of up to 90 mL of enema. Bacterial and endotoxin testing met sterility standards. The addition of Fleet® enema to dialysate increases phosphate concentration in a predictable manner, and no safety problems were observed in our in vitro studies.
夜间血液透析患者中会出现低磷血症。通常会向透析液酸浴中添加磷酸盐，但缺乏对该策略安全性和可靠性的系统评估。本研究有四个目标。首先，我们确定通过添加不同量的灌肠剂（Fleet®灌肠剂）是否可以达到可预测的最终透析液磷酸盐浓度。其次，我们评估了模拟夜间血液透析条件下钙（Ca）和磷酸盐透析液水平的稳定性。第三，我们评估了磷酸钙沉淀情况。最后，我们评估了含有Fleet®灌肠剂的透析液是否符合当前的无菌标准。我们将灌肠剂的系列等分试样添加到4.5 L透析液酸浓缩液中，并在金宝和阿尔辛/百特透析机上调配溶液长达8小时。我们在基线时以及模拟透析4小时和8小时后测量透析液中的磷酸盐、钙、pH值和碳酸氢盐浓度。我们通过肉眼观察和评估620 nm处的光密度来评估沉淀情况。我们使用琼脂接种检测细菌，并使用鲎试剂反应检测内毒素。每添加30 mL Fleet®（1.38 mmol/mL磷酸盐）灌肠剂，透析液磷酸盐浓度增加0.2 mmol/L。8小时内透析液中的磷酸盐、钙、pH值和碳酸氢盐浓度没有显著变化。对于添加量高达90 mL灌肠剂的情况，通过620 nm光密度测量未在透析液中观察到沉淀。细菌和内毒素检测符合无菌标准。向透析液中添加Fleet®灌肠剂可按可预测的方式提高磷酸盐浓度，并且我们的体外研究未观察到安全问题。
