Mortada Wael I, Nabieh Kareem A, Donia Ahmed F, Ismail Amani M, Kenawy Ibrahim M M
Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
J Trace Elem Med Biol. 2016 Jul;36:52-6. doi: 10.1016/j.jtemb.2016.04.004. Epub 2016 Apr 7.
Deficiency of essential trace elements (such as Cu or Zn) and accumulation of potentially toxic trace elements (as Cd or Pb) are both known to have adverse effects in hemodialysis (HD) patients. Up to our knowledge, no studies about the permeability of low and high flux polysulfone membranes on metal ions during hemodialysis are available. Therefore, the aim of the present study was to address this issue. Forty one hemodialysis patients (19 were using high flux polysulfone membrane while the remaining were using low flux one) participated in the study. Blood levels of Cu, Zn, Cd and Pb were determined by graphite furnace atomic absorption spectrometry among HD patients, before and after dialysis session, as well as among matched 40 healthy persons. Blood concentrations of Cu and Zn in the whole hemodialysis group was significantly lower than those of the healthy control group, on the other hand the toxic metals (Cd and Pb) levels were observed to be significantly higher among HD patients compared to the normal persons. Among the hemodialysis group, there were no significant differences between the low and high flux dialyzer groups in terms of pre-dialysis blood levels of Cu, Zn, Cd and Pb. In addition, significantly decreased levels of all metal ions were observed after dialysis sessions using either low or high flux membranes. An exception was Pb which did not show any difference between pre-dialysis and post-dialysis values in the low flux groupIn conclusion Zn and Cu deficiencies should be considered in the treatment of these patients. High flux membranes are more efficient than low flux ones in removing excess Cd and Pb. Therefore, when high flux membranes are used, chelation therapy might not be required for Cd and Pb overload.
已知必需微量元素（如铜或锌）缺乏以及潜在有毒微量元素（如镉或铅）蓄积对血液透析（HD）患者均有不良影响。据我们所知，尚无关于血液透析期间低通量和高通量聚砜膜对金属离子通透性的研究。因此，本研究旨在解决这一问题。41名血液透析患者（19名使用高通量聚砜膜，其余使用低通量聚砜膜）参与了本研究。通过石墨炉原子吸收光谱法测定了HD患者透析前后以及40名匹配的健康人的血液中铜、锌、镉和铅的水平。整个血液透析组的血液中铜和锌的浓度显著低于健康对照组，另一方面，与正常人相比，HD患者中有毒金属（镉和铅）的水平显著更高。在血液透析组中，低通量和高通量透析器组在透析前血液中铜、锌、镉和铅的水平方面没有显著差异。此外，使用低通量或高通量膜进行透析后，所有金属离子的水平均显著下降。低通量组中铅是个例外，其透析前和透析后的值没有差异。总之，在这些患者的治疗中应考虑锌和铜缺乏的情况。高通量膜在去除过量镉和铅方面比低通量膜更有效。因此，当使用高通量膜时，对于镉和铅过载可能不需要螯合疗法。
