Viganò Sara M, Filippo Salvatore Di, Milia Vincenzo La, Pontoriero Giuseppe, Locatelli Francesco
Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco - Italy.
Int J Artif Organs. 2012 May;35(5):346-51. doi: 10.5301/ijao.5000101.
Anemia in chronic kidney disease dialysis patients is a complex syndrome involving many causes. Adequate dialysis can contribute to its correction through many mechanisms, including the removal of molecules that may inhibit erythropoiesis. The aim of this pilot study was to evaluate the effect on renal anemia of two synthetic, high-flux dialyzers (polynephron vs. high-flux polysulphone).
20 dialysis patients (11 male; mean age: 72 years) were randomly assigned and studied for 6 months. There were 2 dropouts in each group. Each patient underwent 3 hemodialysis treatments per week without any difference in dialysis prescription. At T = 0 and T = 6 (after 6 months), instantaneous plasma clearances and reduction rates of small solutes, ß2-microglobulin protein (ß2-µ); hemoglobin (Hb), and iron pattern were measured. The effect on anemia was evaluated by calculating the Erythropoesis Stimulating Agent (ESA) doses and the Erythropoietin Resistance Index (ERI).
Kt/V increased between T0 and T6 in both groups. ß2-µ pre-dialysis levels significantly decreased between T0 and T6 in both dialyzer groups (p<0.001 in both groups). The Hb levels increased between T0 and T6, but significantly only for the polynephron patient group (p = 0.006 and 0.142). ESA dose did not change significantly. The ERI decreased by 22.7% between T0 and T6 in the polynephron-group and increased by 14% in the others; these changes were not significant.
High-flux filters improved Hb levels, although only significantly in the polynephron group, suggesting a possible different effect. The results should be interpreted with caution and tested in an appropriately powered, large, prospective, randomized control trial.
慢性肾脏病透析患者的贫血是一种涉及多种病因的复杂综合征。充分透析可通过多种机制有助于纠正贫血，包括清除可能抑制红细胞生成的分子。本初步研究的目的是评估两种合成的高通量透析器（聚肾素与高通量聚砜）对肾性贫血的影响。
20名透析患者（11名男性；平均年龄：72岁）被随机分组并研究6个月。每组有2名退出者。每位患者每周接受3次血液透析治疗，透析处方无差异。在T = 0和T = 6（6个月后）时，测量小溶质、β2-微球蛋白（β2-µ）的瞬时血浆清除率和降低率、血红蛋白（Hb）以及铁代谢指标。通过计算促红细胞生成素刺激剂（ESA）剂量和促红细胞生成素抵抗指数（ERI）来评估对贫血的影响。
两组在T0和T6之间Kt/V均增加。两个透析器组在T0和T6之间透析前β2-µ水平均显著降低（两组均p<0.001）。Hb水平在T0和T6之间升高，但仅聚肾素患者组有显著升高（p = 0.006和0.142）。ESA剂量无显著变化。聚肾素组在T0和T_{6}之间ERI下降了22.7%，其他组上升了14%；这些变化无显著意义。
高通量滤器改善了Hb水平，尽管仅在聚肾素组有显著改善，提示可能存在不同效应。结果应谨慎解读，并在具有适当样本量的大型前瞻性随机对照试验中进行验证。
