Department of Nephrology Dialysis and Transplantation, and International Renal Research Institute (IRRIV), St. Bortolo Hospital, Vicenza, Italy.
Blood Purif. 2013;35(1-3):8-15. doi: 10.1159/000345755. Epub 2013 Jan 22.
The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they consume. Death is the thermodynamically favored state: it represents a large increase in entropy as molecular structure yields to chaos. The kidney is an organ dissipating large amounts of energy to maintain the level of entropy of the organism as low as possible. Diseases, and in particular uremia, represent conditions of rapid increase in entropy. Therapeutic strategies are oriented towards a reduction in entropy or at least a decrease in the speed of entropy increase. Uremia is a process accelerating the trend towards randomness and disorder (increase in entropy). Dialysis is a factor external to the patient that tends to reduce the level of entropy caused by kidney disease. Since entropy can only increase in closed systems, energy and work must be spent to limit the entropy of uremia. This energy should be adapted to the system (patient) and be specifically oriented and personalized. This includes a multidimensional effort to achieve an adequate dialysis that goes beyond small molecular weight solute clearance. It includes a biological plan for recovery of homeostasis and a strategy towards long-term rehabilitation of the patient. Such objectives can be achieved with a combination of technology and innovation to answer specific questions that are still present after 60 years of dialysis history. This change in the individual bioentropy may represent a local exception to natural trends as the patient could be considered an isolated universe responding to the classic laws of thermodynamics.
热力学第二定律适用于病史和治疗干预的局部例外。生物在时间上保持其低熵水平，因为它们以食物的形式从周围环境中获取能量。它们以消耗营养物质的混乱为代价获得秩序。死亡是热力学上有利的状态：它代表着熵的大量增加，因为分子结构向混沌屈服。肾脏是一种消耗大量能量来维持生物体熵尽可能低的器官。疾病，特别是尿毒症，代表着熵迅速增加的情况。治疗策略旨在减少熵，或者至少降低熵增加的速度。尿毒症是一个加速随机性和无序性（熵增加）趋势的过程。透析是一种患者外部的因素，倾向于降低由肾脏疾病引起的熵水平。由于熵只能在封闭系统中增加，因此必须消耗能量和功来限制尿毒症的熵。这种能量应该适应系统（患者），并具有特定的方向和个性化。这包括为恢复内稳态和患者长期康复制定一个生物计划，这需要超越小分子溶质清除率。这些目标可以通过技术和创新的结合来实现，以回答在透析历史 60 年后仍然存在的具体问题。这种个体生物熵的变化可能代表了自然趋势的局部例外，因为患者可以被视为一个孤立的宇宙，对经典热力学定律做出反应。
