Melo Natalia C V, Moyses Rosa M A, Elias Rosilene M, Castro Manuel C M
Nephrology Division, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; HRT-SES/DF, Brasilia, Brazil.
Hemodial Int. 2014 Apr;18(2):473-80. doi: 10.1111/hdi.12126. Epub 2014 Jan 7.
There are no studies evaluating the impact of dialyzer reprocessing on solute removal in short-daily online hemodiafiltration (OL-HDF). Our aim was to evaluate the impact of dialyzer reuse on solute removal in daily OL-HDF and compare with that in high-flux short-daily hemodialysis (SDH). Fourteen patients undergoing a SDH program were included. Pre-dialysis and post-dialysis blood samples and effluent dialysate were collected in the 1st, 7th, and 13th dialyzer uses in SDH sessions and in daily OL-HDF sessions. Directly quantified small solute (urea, phosphorus, creatinine, and uric acid) total mass removal (TM(DQ)) and clearance (K(DQ)) were similar when the 1st, 7th, and 13th dialyzer SDH uses were compared with the 1st, 7th, and 13th daily OL-HDF uses. TMDQ and K(DQ) of small solutes were similar among analyzed dialyzer uses in SDH sessions and in daily OL-HDF sessions. β2-Microglobulin TM(DQ) and K(DQ) were statistically higher in daily OL-HDF dialyzer uses than in the respective SDH uses. There was no difference in β2-microglobulin TM(DQ) and K(DQ) among dialyzer uses in daily OL-HDF sessions or in SDH sessions. In daily OL-HDF, albumin loss was significantly different among dialyzer uses (P < 0.001), being lower in the 7th and 13th dialyzer uses than in the first use. Dialyzer reprocessing did not impair solute extraction in daily OL-HDF. β2-Microglobulin removal was greater in daily OL-HDF than in SDH sessions, without significant differences in other solutes extraction. There was a significant reduction in intradialytic albumin loss with dialyzer reprocessing in daily OL-HDF sessions.
尚无研究评估透析器复用对短程每日在线血液透析滤过(OL-HDF)中溶质清除的影响。我们的目的是评估透析器复用对每日OL-HDF中溶质清除的影响,并与高通量短程每日血液透析(SDH)进行比较。纳入了14例接受SDH治疗方案的患者。在SDH治疗疗程以及每日OL-HDF治疗疗程中,于透析器第1次、第7次和第13次使用时采集透析前和透析后的血样以及透析废液。当比较SDH中透析器第1次、第7次和第13次使用与每日OL-HDF中透析器第1次、第7次和第13次使用时,直接定量的小溶质(尿素、磷、肌酐和尿酸)的总质量清除率(TM(DQ))和清除率(K(DQ))相似。在SDH治疗疗程和每日OL-HDF治疗疗程中,所分析的透析器使用次数之间,小溶质的TM(DQ)和K(DQ)相似。每日OL-HDF透析器使用中β2-微球蛋白的TM(DQ)和K(DQ)在统计学上高于相应的SDH使用。在每日OL-HDF治疗疗程或SDH治疗疗程中,透析器不同使用次数之间β2-微球蛋白的TM(DQ)和K(DQ)没有差异。在每日OL-HDF中,透析器不同使用次数之间白蛋白丢失存在显著差异(P<0.001),第7次和第13次透析器使用时的白蛋白丢失低于第1次使用时。透析器复用并未损害每日OL-HDF中的溶质清除。每日OL-HDF中β2-微球蛋白的清除高于SDH治疗疗程,其他溶质清除无显著差异。在每日OL-HDF治疗疗程中,透析器复用使透析中白蛋白丢失显著减少。