Bello V A, Gitelman H J
School of Medicine, University of North Carolina, Chapel Hill.
Am J Kidney Dis. 1990 Apr;15(4):320-4. doi: 10.1016/s0272-6386(12)80078-3.
The observation of higher plasma flouride levels in our hemodialysis (HD) patients than our continuous ambulatory peritoneal dialysis (CAPD) patients (4.0 +/- 0.5 mumol/L [n = 17] v 2.5 +/- 0.3 mumol/L [n = 17], P less than 0.005) prompted an evaluation of fluoride metabolism during HD. We found that serum fluoride was completely ultrafiltrable across cuprophane membranes (99% +/- 4%) and that HD produced acute changes in plasma fluoride levels that correlated well with the fluoride gradient between plasma and dialysis fluid at the start of dialysis. Our HD fluids contained significantly higher fluoride concentrations than were present in commercially prepared peritoneal dialysis fluid. Our fluids are prepared from fluoridated tap water that is purified by reverse osmosis (RO). We conclude that the different concentrations of fluoride in our dialysis fluids account for the differences in the plasma flouride concentrations between our dialysis groups. Since many HD units rely on RO systems to purify fluoridated tap water, it is likely that many HD patients are being exposed inadvertently to increased concentrations of fluoride.
我们观察到血液透析（HD）患者的血浆氟水平高于持续性非卧床腹膜透析（CAPD）患者（4.0±0.5μmol/L [n = 17] 对比 2.5±0.3μmol/L [n = 17]，P＜0.005），这促使我们对HD期间的氟代谢进行评估。我们发现血清氟可完全透过铜仿膜超滤（99%±4%），并且HD会使血浆氟水平产生急性变化，这与透析开始时血浆和透析液之间的氟梯度密切相关。我们的HD液中氟浓度明显高于市售腹膜透析液中的氟浓度。我们的透析液由经反渗透（RO）纯化的氟化自来水配制而成。我们得出结论，透析液中不同的氟浓度导致了我们透析组之间血浆氟浓度的差异。由于许多血液透析单位依靠RO系统来纯化氟化自来水，很可能许多血液透析患者在无意中接触到了更高浓度的氟。
