通过专门设计用于高容量对流治疗的透析器清除大量尿毒症毒素。

Elimination of large uremic toxins by a dialyzer specifically designed for high-volume convective therapies.

作者信息

Maduell F, Arias-Guillen M, Fontseré N, Ojeda R, Rico N, Vera M, Elena M, Bedini J L, Wieneke P, Campistol J M

机构信息

Departments of Nephrology and Renal Transplantation, Hospital Clínic Barcelona, Barcelona, Spain.

出版信息

Blood Purif. 2014;37(2):125-30. doi: 10.1159/000358214. Epub 2014 Mar 20.

DOI:10.1159/000358214

PMID:24662288

Abstract

BACKGROUND

Unlike conventional hemodialysis treatments, which rely almost solely on diffusion-related mechanisms for solute removal, hemodiafiltration (HDF) allows more efficient removal of higher molecular weight toxins due to convective transport mechanisms. To facilitate the removal of these toxins in HDF treatment modalities, dialyzers with highly efficient high-flux membranes are necessary. This study assessed the large uremic toxin removal ability of a high-flux dialyzer (FX CorDiax 60) specifically designed to facilitate convective therapies compared with a standard high-flux dialyzer (FX 60).

METHODS

In an open, randomized, cross-over, single-center, controlled, prospective clinical study, 30 adult chronic hemodialysis patients were treated by post-dilution online HDF with the FX 60 or the FX CorDiax 60 dialyzer. All other dialysis parameters were kept constant in both study arms. The reduction rate (RR) of blood urea nitrogen, phosphate, β2-microglobulin (β2-m), myoglobin, prolactin, α1-microglobulin, α1-acid glycoprotein, albumin and total protein as well as the elimination into dialysate was intraindividually compared for the two dialyzer types.

RESULTS

For FX CorDiax 60 versus FX 60, the RR was significantly higher for blood urea nitrogen (86.23 ± 4.14 vs. 84.89 ± 4.59%, p = 0.015), β2-m (84.67 ± 3.79 vs. 81.30 ± 4.82%, p < 0.0001), myoglobin (75.23 ± 10.48 vs. 58.60 ± 12.1%, p < 0.0001), prolactin (72.96 ± 9.68 vs. 56.91 ± 13.01%, p < 0.0001) and α1-microglobulin (20.89 ± 18.27 vs. 13.60 ± 12.50%, p = 0.016). There were no significant differences in the RR for phosphate, α1-acid glycoprotein, albumin and total protein. Mass removal was significantly higher with the FX CorDiax 60 than with the FX 60 for β2-m (0.26 ± 0.09 vs. 0.24 ± 0.09 g, p = 0.0006), myoglobin (1.83 ± 0.89 vs. 1.51 ± 0.76 mg, p = 0.0017), prolactin (0.17 ± 0.13 vs. 0.14 ± 0.08 mg, p = 0.02) and albumin (4.25 ± 3.49 vs. 3.01 ± 2.37 g, p = 0.03).

CONCLUSIONS

This study demonstrates that treating patients with an FX CorDiax 60 instead of an FX 60 dialyzer in post-dilution HDF mode significantly increases the elimination of middle molecules.

摘要

背景

与几乎完全依赖扩散相关机制进行溶质清除的传统血液透析治疗不同，血液透析滤过（HDF）由于对流传输机制，能够更有效地清除高分子量毒素。为便于在HDF治疗模式中清除这些毒素，需要配备高效高通量膜的透析器。本研究评估了一种专门设计用于促进对流治疗的高通量透析器（FX CorDiax 60）与标准高通量透析器（FX 60）相比，对尿毒症毒素的清除能力。

方法

在一项开放、随机、交叉、单中心、对照、前瞻性临床研究中，30例成年慢性血液透析患者分别使用FX 60或FX CorDiax 60透析器进行后置式在线HDF治疗。两个研究组的所有其他透析参数均保持恒定。对两种透析器类型的尿素氮、磷酸盐、β2-微球蛋白（β2-m）、肌红蛋白、催乳素、α1-微球蛋白、α1-酸性糖蛋白、白蛋白和总蛋白的清除率（RR）以及向透析液中的清除情况进行个体内比较。

结果

与FX 60相比，FX CorDiax 60的尿素氮RR显著更高（86.23±4.14对84.89±4.59%，p = 0.015），β2-m（84.67±3.79对81.30±4.82%，p < 0.0001），肌红蛋白（75.23±10.48对58.60±12.1%，p < 0.0001），催乳素（72.96±9.68对56.91±13.01%，p < 0.0001）和α1-微球蛋白（20.89±18.27对13.60±12.50%，p = 0.016）。磷酸盐、α1-酸性糖蛋白、白蛋白和总蛋白的RR无显著差异。FX CorDiax 60对β2-m（0.26±0.09对0.24±0.09 g，p = 0.0006）、肌红蛋白（1.83±0.89对1.51±0.76 mg，p = 0.0017）、催乳素（0.17±0.13对0.14±0.08 mg，p = 0.02）和白蛋白（4.25±3.49对3.01±2.37 g，p = 0.03）的质量清除显著高于FX 60。