Zucchelli P, Botella J, Spongano M, Santoro A, Sanz-Moreno C
Divisione di Nefrologia e Dialisi, Ospedale Malpighi, Bologna, Italy.
Nephron. 1990;56(2):166-73. doi: 10.1159/000186127.
To overcome reciprocal interaction between convection and diffusion occurring in hemodiafiltration, we separated the two processes in a new dialysis technique called paired filtration dialysis (PFD). In this technique, convection and diffusion take place separately on two capillary membranes: a polysulfone hemofilter and a hemophan dialyzer. The depurative effectiveness of PFD with respect to small (blood urea nitrogen, creatinine, uric acid, phosphate) and large (beta 2-microglobulin) molecules was acutely assessed in 6 patients on maintenance acetate hemodialysis. Despite a 3-hour treatment time, a high mass removal of small and large solutes was found in PFD without high ultrafiltration rates or blood flows in excess of 300 ml/min. There was no significant difference in solute removal between the two different depurative sequences adopted in PFD, i.e., convection followed by diffusion or vice versa. A significant reduction in beta 2-microglobulin serum levels was observed in both PFD modes. Twenty patients, on a 12-month period of 3-hour PFD treatment, maintained an unaltered metabolic, clinical, and acid-base status, and cardiovascular stability was not affected. PFD thus provides excellent depurative results, along with simple technical features that are particularly useful in treating patients with high depurative needs and yet are unable to tolerate high-flux techniques.
为了克服血液透析滤过中对流与扩散之间的相互作用，我们在一种名为配对滤过透析（PFD）的新透析技术中分离了这两个过程。在该技术中，对流和扩散分别在两个毛细血管膜上进行：一个聚砜血液滤过器和一个血仿透析器。对6例维持性醋酸盐血液透析患者急性评估了PFD对小分子（血尿素氮、肌酐、尿酸、磷酸盐）和大分子（β2-微球蛋白）的净化效果。尽管治疗时间为3小时，但在PFD中发现对大小溶质的高清除量，且超滤率不高或血流速度不超过300 ml/min。PFD采用的两种不同净化顺序（即先对流后扩散或反之）之间的溶质清除率无显著差异。在两种PFD模式下均观察到β2-微球蛋白血清水平显著降低。20例患者在为期12个月的3小时PFD治疗期间，维持了未改变的代谢、临床和酸碱状态，且心血管稳定性未受影响。因此，PFD提供了出色的净化效果，同时具有简单的技术特点，这在治疗有高净化需求但无法耐受高通量技术的患者时特别有用。
