Tsuchida Kenji, Minakuchi Jun
Contrib Nephrol. 2011;173:76-83. doi: 10.1159/000328957. Epub 2011 Aug 8.
Beta-2-microglobulin (β(2)M) clearance has been improved in recent dialysis membranes and minimum albumin leakage has been achieved in most membranes today since dialysis membranes are now classified by β(2)M clearance in terms of the reimbursement by health insurance. Kawanishi et al. suggested that 'the desirable albumin leakage in one treatment is less than 4 g '. Function classification type IV or type V dialysis membranes have leakages as low as 3 g, while most resulted in < 1 g leakage. However, some high-performance membranes (HPMs) have around 8 g of leakage, which requires further study of the clinical efficacy using such dialysis membranes. The comparison of albumin leakage in one dialysis treatment (4 h: blood flow volume of 250 ml/min) revealed that PES-210D has an overwhelmingly high albumin leakage of 7.69 ± 1.01 g. The data were without any significant difference between the PES-D membrane user group and the non-PES-D membrane user group for hemoglobin, hematocrit, β(2)M protein, catabolic rate, body mass index, and muscle mass. However, the PES-D membrane user group had a significantly lower number of hospitalizations and other complication events. When comparing the event contents, the PES-D membrane user group had no cardiac failure and lower DRA, however it had more vascular access problems. In normal renal function, approximately 10 g of albumin is filtered in the glomerulus per day, decomposed in the renal tubule and reabsorbed as amino acid, and re-synthesized into albumin in the liver. On the contrary, in dialysis patients, albumin that is bound to biologically active substances and/or the oxidized form of albumin that has lost its antioxidant effect cannot be filtered from the kidney and accumulate. Therefore, the idea regarding albumin leakage is to remove biologically active substances that bind to albumin and function as uremic toxin, remove albumin without the antioxidant effect, and facilitate synthesis of new albumin with an antioxidant effect.
近年来，透析膜对β2微球蛋白（β(2)M）的清除能力有所提高，如今大多数透析膜已实现最低白蛋白漏出量，因为目前透析膜是根据β(2)M清除能力进行医保报销分类的。川西等人指出，“一次治疗中理想的白蛋白漏出量应小于4克”。功能分类为IV型或V型的透析膜漏出量低至3克，而大多数透析膜的漏出量小于1克。然而，一些高性能膜（HPM）的漏出量约为8克，这需要进一步研究使用此类透析膜的临床疗效。对一次透析治疗（4小时：血流量250毫升/分钟）中白蛋白漏出量的比较显示，PES - 210D的白蛋白漏出量极高，为7.69±1.01克。在血红蛋白、血细胞比容、β(2)M蛋白、分解代谢率、体重指数和肌肉量方面，使用PES - D膜的患者组和未使用PES - D膜的患者组之间的数据无显著差异。然而，使用PES - D膜的患者组住院次数和其他并发症事件明显较少。比较事件内容时，使用PES - D膜的患者组没有心力衰竭且DRA较低，但血管通路问题较多。在肾功能正常时，每天约有10克白蛋白在肾小球被滤过，在肾小管中分解并作为氨基酸被重吸收，然后在肝脏中重新合成白蛋白。相反，在透析患者中，与生物活性物质结合的白蛋白和/或失去抗氧化作用的氧化形式的白蛋白无法从肾脏滤过并积累。因此，关于白蛋白漏出的理念是去除与白蛋白结合并作为尿毒症毒素起作用的生物活性物质，去除没有抗氧化作用的白蛋白，并促进具有抗氧化作用的新白蛋白的合成。
