Department of Intensive Care Medicine, Montpellier University Hospital, Montpellier, France.
Department of nephrology, Clinique Médipole, Perpignan, France.
Blood Purif. 2018;46(3):248-256. doi: 10.1159/000489082. Epub 2018 Jul 4.
High cut-off (HCO) continuous veno-venous hemodialysis (CVVHD) was compared to high-flux membrane (HFM) continuous veno-venous hemodiafiltration (CVVHDF) in intensive care unit (ICU) acute kidney injury (AKI) in terms of efficiency, hemodynamic tolerance, medium-sized molecules removal, albumin loss, and inflammatory system activation.
In a prospective cross-over randomized study, 10 AKI patients underwent successively HCO (Ultraflux EmiC2: β2-microglobulin [β2M] sieving coefficient [SC]: 0.9) CVVHD and HFM (Ultraflux AV1000S: β2M SC: 0.65) -CVVHDF.
Over the 20 sessions, hypotensive and febrile episodes, reduction rates of urea, creatinine, and β2M were similar in both modalities. Though dialysis dose was higher with CVVHDF (36 ± 4 vs. 21 ± 6 mL/Kg/h), urea, creatinine, and β2M instantaneous and plasmatic clearances did not differ except for urea at 12 h. Protein loss, superoxide anion production, cytokines, and growth factors variations were also comparable.
HCO CVVHD is well tolerated and is as effective as HFM CVVHDF in clearance of solutes and removal of β2M. It induces neither protein loss nor overproduction of superoxide anion. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=489082.
在重症监护病房（ICU）急性肾损伤（AKI）患者中，比较高截止（HCO）连续性静脉-静脉血液透析（CVVHD）与高通量膜（HFM）连续性静脉-静脉血液透析滤过（CVVHDF）在效率、血液动力学耐受性、中分子物质清除、白蛋白丢失和炎症系统激活方面的差异。
在一项前瞻性交叉随机研究中，10 例 AKI 患者先后接受 HCO（Ultraflux EmiC2：β2-微球蛋白[β2M]筛系数[SC]：0.9）CVVHD 和 HFM（Ultraflux AV1000S：β2M SC：0.65）-CVVHDF。
在 20 次治疗中，两种方式均出现低血压和发热发作，尿素、肌酐和β2M 的降低率相似。尽管 CVVHDF 的透析剂量更高（36±4 与 21±6 mL/Kg/h），但尿素、肌酐和β2M 的即时和血浆清除率并无差异，除了 12 小时的尿素。蛋白丢失、超氧阴离子产生、细胞因子和生长因子的变化也相似。
HCO CVVHD 耐受性良好，与 HFM CVVHDF 在溶质清除和β2M 去除方面同样有效。它既不会引起蛋白丢失，也不会引起超氧阴离子的过度产生。视频期刊俱乐部“克劳迪奥·罗恩科的卡布奇诺”在 http://www.karger.com/?doi=489082。
