Hirayama Takahiro, Nosaka Nobuyuki, Okawa Yasumasa, Ushio Soichiro, Kitamura Yoshihisa, Sendo Toshiaki, Ugawa Toyomu, Nakao Atsunori
Department of Clinical Engineering, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama city, 700-8558 Japan.
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama city, 700-8558 Japan.
J Intensive Care. 2017 Jul 18;5:46. doi: 10.1186/s40560-017-0244-x. eCollection 2017.
In Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT). The dialyzer membrane AN69ST has been reported to adsorb NM and affect the management of anticoagulant therapy. However, the adsorbed amount has not yet been quantitatively assessed. Therefore, in this study, we evaluated the pre- and post-hemofilter prolongation of the activated clotting time (ACT) in patients with AN69ST and PS membranes. We also measured the adsorption of NM in three types of CRRT membranes using an experimental model.
In a study of patients who underwent CRRT using AN69ST or PS membranes in 2015 at the Advanced Emergency and Critical Care Center, Okayama University Hospital, pre- and post-hemofilter ACT measurements were extracted retrospectively, and the difference was calculated. In addition, AN69ST (sepXiris100), PS (HEMOFEEL SHG-1.0), and PMMA membranes (HEMOFEEL CH-1.0N) were used in an in vitro model of a dialysis circuit, and the concentrations of NM were measured in pre- and post-hemofilter membranes and filtrates.
The ACT difference was significantly lower in the group using AN69ST membranes ( < 0.01). In the in vitro model ( = 4) with adsorption and filtration, the post-hemofilter and filtrate concentrations of NM in AN69ST membranes were significantly lower than those in the PS and PMMA membranes ( < 0.01). The NM adsorption clearance of the AN69ST membrane was significantly higher than that of the PS and PMMA membranes.
The AN69ST membrane had higher NM adsorption than the PS and PMMA membranes. This may have resulted in the lower ACT difference in patients undergoing CRRT using the AN69ST membrane than in patients undergoing CRRT using PS or PMMA membranes.
在日本，甲磺酸萘莫司他（NM）在持续肾脏替代治疗（CRRT）期间常被用作抗凝剂。据报道，透析器膜AN69ST会吸附NM并影响抗凝治疗的管理。然而，吸附量尚未进行定量评估。因此，在本研究中，我们评估了使用AN69ST和聚砜（PS）膜的患者在血液滤过器前后活化凝血时间（ACT）的延长情况。我们还使用实验模型测量了三种CRRT膜中NM的吸附情况。
在一项对2015年在冈山大学医院高级急救与重症监护中心使用AN69ST或PS膜进行CRRT的患者的研究中，回顾性提取血液滤过器前后的ACT测量值，并计算差值。此外，在透析回路的体外模型中使用AN69ST（sepXiris100）、PS（HEMOFEEL SHG-1.0）和聚甲基丙烯酸甲酯（PMMA）膜，测量血液滤过器前后膜和滤液中NM的浓度。
使用AN69ST膜的组中ACT差值显著更低（<0.01）。在有吸附和过滤的体外模型（n = 4）中，AN69ST膜中血液滤过器后和滤液中NM的浓度显著低于PS和PMMA膜中的浓度（<0.01）。AN69ST膜的NM吸附清除率显著高于PS和PMMA膜。
AN69ST膜比PS和PMMA膜具有更高的NM吸附性。这可能导致使用AN69ST膜进行CRRT的患者的ACT差值低于使用PS或PMMA膜进行CRRT的患者。
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