Kimura G, Kojima S, Kawano Y, Imanishi M, Kuramochi M, Omae T
Division of Nephrology, National Cardiovascular Center, Osaka, Japan.
Am J Kidney Dis. 1989 Mar;13(3):226-31. doi: 10.1016/s0272-6386(89)80056-3.
Because the total amount of waste products removed by hemofiltration can be measured exactly, it was divided into two components, that removed from the extracellular compartment and that removed from the intracellular compartment, using inulin as a marker for extracellular fluid in five uremic patients treated with hemofiltration in the postdilution mode. The amount removed from the extracellular compartment as a proportion to the total amount removed from the whole body by hemofiltration was 86.5% +/- 10.6% for guanidinosuccinic acid, 69.1% +/- 15.6% for sodium, 59.4% +/- 3.3% for uric acid, 56.4% +/- 2.1% for inorganic phosphate, 45.6% +/- 5.3% for creatinine, 43.1% +/- 7.2% for potassium, 42.9% +/- 3.1% for guanidinoacetic acid, 42.5% +/- 7.5% for methylguanidine, 37.2% +/- 8.4% for chloride, 36.3% +/- 2.8% for urea, and 6.9% +/- 2.9% for glucose. These results show that extracellular substances such as sodium and guanidinosuccinic acid were removed mainly from the extracellular compartment. On the other hand, glucose was removed only from the intracellular compartment, since blood glucose level is regulated. Although uric acid, inorganic phosphate, creatinine, potassium, guanidinoacetic acid, and methylguanidine are intracellular substances, they accumulated also in the extracellular fluid in renal failure, and were removed from both compartments, intracellular as well as extracellular, by hemofiltration.
由于通过血液滤过清除的废物总量能够被精确测量，因此在5例采用后稀释模式进行血液滤过治疗的尿毒症患者中，以菊粉作为细胞外液的标志物，将其分为从细胞外间隙清除的部分和从细胞内间隙清除的部分。通过血液滤过从细胞外间隙清除的量占从全身清除总量的比例，对于胍基琥珀酸为86.5%±10.6%，对于钠为69.1%±15.6%，对于尿酸为59.4%±3.3%，对于无机磷酸盐为56.4%±2.1%，对于肌酐为45.6%±5.3%，对于钾为43.1%±7.2%，对于胍基乙酸为42.9%±3.1%，对于甲基胍为42.5%±7.5%，对于氯为37.2%±8.4%，对于尿素为36.3%±2.8%，对于葡萄糖为6.9%±2.9%。这些结果表明，钠和胍基琥珀酸等细胞外物质主要从细胞外间隙被清除。另一方面，由于血糖水平受到调节，葡萄糖仅从细胞内间隙被清除。尽管尿酸、无机磷酸盐、肌酐、钾、胍基乙酸和甲基胍是细胞内物质，但在肾衰竭时它们也在细胞外液中蓄积，并通过血液滤过从细胞内和细胞外两个间隙被清除。
