Herrera-Gutiérrez M E, Seller-Pérez G, Arias Verdu D, Jironda-Gallegos C, Martín-Velázquez M, Quesada-García G
ICU, Carlos Haya Hospital, Carlos Haya Avenue s/n, 29010 Málaga, Spain.
Nephrology, Carlos Haya Hospital, 29010 Málaga, Spain.
ISRN Nephrol. 2012 Dec 20;2013:185989. doi: 10.5402/2013/185989. eCollection 2013.
AN69 membrane is not suited for diffusion, with an suggested limit at 25 mL/min dialysate flow rate. When prescribing continuous hemodialysis this threshold must be surpassed to achieve. We designed a study aimed to check if a higher dose of dialysis could be delivered efficiently with this membrane. Ten ICU patients under continuous hemodiafiltration with 1.4 m(2) AN69 membrane were included and once a day we set the monitor to exclusively 50 mL/min dialysate flow rate and 250 mL/min blood flow rate and after 15 minutes measured dialysate saturation for urea, creatinine, and β 2-microglobulin. We detected that urea saturation of dialysate was nearly complete (1.1 ± 0.09) for at least 40 hours, while creatinine saturation showed a large dispersion (0.86 ± 0.22) and did not detect any relation for these variables with time, blood flow, or anticoagulation regime. Saturation of β 2-microglobulin was low (0.34 ± 0.1) and decreased discretely with time (r (2) = 0.15, P < 0.05) and significantly with TMP increases (r (2) = 0.31, P < 0.01). In our experience AN69 membrane shows a better diffusive capability than previously acknowledged, covering efficiently the range of standard dosage for continuous therapies. Creatinine is not a good marker of the membrane diffusive capability.
AN69膜不适合用于扩散，建议的透析液流速上限为25毫升/分钟。在进行持续性血液透析时，必须超过这个阈值才能实现目标。我们设计了一项研究，旨在检查使用这种膜是否能够有效地提供更高剂量的透析。纳入了10例使用1.4平方米AN69膜进行持续性血液滤过的重症监护病房患者，每天一次，我们将监测器设置为仅50毫升/分钟的透析液流速和250毫升/分钟的血流速，15分钟后测量透析液中尿素、肌酐和β2-微球蛋白的饱和度。我们检测到，透析液中尿素饱和度在至少40小时内几乎达到完全饱和（1.1±0.09），而肌酐饱和度差异较大（0.86±0.22），且未发现这些变量与时间、血流或抗凝方案之间存在任何关系。β2-微球蛋白的饱和度较低（0.34±0.1），并随时间逐渐降低（r(2)=0.15，P<0.05），且随跨膜压升高显著降低（r(2)=0.31，P<0.01）。根据我们的经验，AN69膜的扩散能力比之前认为的更好，能够有效地覆盖持续性治疗的标准剂量范围。肌酐不是膜扩散能力的良好标志物。
