Oshihara Wataru, Ueno Yoshiyuki, Fujieda Hiroaki
Contrib Nephrol. 2017;189:222-229. doi: 10.1159/000450805. Epub 2016 Dec 12.
The biggest problem in routine hemodialysis therapy is possibly the blood pressure fall experienced by patients during dialysis. In contrast, in medium- and long-term hemodialysis therapy, the main problem might be deterioration of arteriosclerosis because of medial calcification associated with dialysis vintage. Both problems are caused by an autonomic imbalance or structural change in the blood vessels. Inflammation due to extracorporeal blood circulation is another possible cause. This inflammation is considered to cause platelets activated by contact and adherence with the membrane surface to aggregate with white blood cells and attack the endothelium of the blood vessels. Therefore, we tried to develop a new membrane with no adsorption and no platelet activation.
Polysulfone (PS) membranes with polyvinylpyrrolidone (PVP) as a hydrophilic agent are widely used in dialysis, but blood components adhere to the membrane surface. We developed a new dialyzer, NV, by localizing a new hydrophilic polymer onto the inner surface of a hollow-fiber membrane composed of PS and PVP. The number of platelets that adhered to the NV membrane surface drastically decreased to 0.9% of that with the conventional PS dialysis membrane. We also confirmed the mechanism by which NV realizes clinical improvements in blood pressure drops and inflammation during dialysis, and verified its clinical appeal. Key Messages: The new membrane NV, which inhibits platelet adhesion and is compatible with blood vessels, is clinically beneficial.
常规血液透析治疗中最大的问题可能是患者在透析过程中出现血压下降。相比之下,在中长期血液透析治疗中,主要问题可能是由于与透析时间相关的中层钙化导致的动脉硬化恶化。这两个问题都是由自主神经失衡或血管结构变化引起的。体外血液循环引起的炎症是另一个可能的原因。这种炎症被认为会导致因与膜表面接触和黏附而活化的血小板与白细胞聚集,并攻击血管内皮。因此,我们试图开发一种无吸附且无血小板活化的新型膜。
以聚乙烯吡咯烷酮(PVP)作为亲水剂的聚砜(PS)膜在透析中被广泛使用,但血液成分会黏附于膜表面。我们通过将一种新型亲水性聚合物定位在由PS和PVP组成的中空纤维膜的内表面,开发出了一种新型透析器NV。黏附于NV膜表面的血小板数量大幅减少至传统PS透析膜的0.9%。我们还证实了NV实现透析过程中血压下降和炎症临床改善的机制,并验证了其临床吸引力。关键信息:新型膜NV可抑制血小板黏附且与血管相容,具有临床益处。