Wu Buyun, Ji Daxi, Xu Bin, Fan Rong, Gong Dehua
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Hemodial Int. 2019 Apr;23(2):181-188. doi: 10.1111/hdi.12709. Epub 2019 Feb 11.
Micronutrient depletion is a major drawback of high-dose continuous renal replacement therapy (CRRT). We tested two novel CRRT modes, double-filtration hemofiltration (DHF) and dialysate-recycling hemodiafiltration (DHDF), aimed at reducing micronutrient loss while maintaining a high clearance rate of midsized solutes comparable to that of high-volume hemofiltration (HVHF).
Forty patients with renal failure requiring CRRT were randomly assigned to receive predilutional standard-volume hemofiltration (SVHF, effluent rate 35 mL/kg/h), predilutional HVHF (100 mL/kg/h), DHF (35 mL/kg/h), and DHDF (30 mL/kg/h). In the two novel modes of CRRT, part of the high-volume primary effluent fluid produced by a high-flux filter (AV600S) was refiltered by two low-flux filters (15 L) for recycling as replacement fluid in DHF and dialysate in DHDF, while the remainder was discarded as final effluent fluid. Specimens were collected for measurement of trace elements, folic acid, amino acids (AAs), β2-microglobulin, cystatin C, and creatinine and for calculation of solute clearance.
The clearance of 17 AAs, phosphorus, folic acid, copper, and zinc by DHF and DHDF was much lower than that by HVHF and comparable to that by SVHF. The estimated amount of AA loss by SVHF, HVHF, DHF, and DHDF was 10.3 (7.2-13.4) g/d, 22.1 (17.8-24.0) g/d, 10.6 (8.6-14.0) g/d, and 10.0 (8.6-11.4) g/d, respectively. Clearance of cystatin C and β2-microglobulin by DHF and DHDF was much greater than that by SVHF and equal to that by HVHF.
Compared to HVHF, DHF, and DHDF have an equal capacity for removal of large solutes but show substantially reduced micronutrient loss.
微量营养素消耗是高剂量连续性肾脏替代治疗（CRRT）的一个主要缺点。我们测试了两种新型CRRT模式，双重滤过血液滤过（DHF）和透析液再循环血液透析滤过（DHDF），旨在减少微量营养素损失，同时保持与高容量血液滤过（HVHF）相当的中分子溶质高清除率。
40例需要CRRT的肾衰竭患者被随机分配接受预稀释标准容量血液滤过（SVHF，滤出液速率35 mL/kg/h）、预稀释HVHF（100 mL/kg/h）、DHF（35 mL/kg/h）和DHDF（30 mL/kg/h）。在这两种新型CRRT模式中，高通量滤器（AV600S）产生的部分高容量原滤出液由两个低通量滤器（15 L）进行再过滤，以便在DHF中作为置换液再循环，在DHDF中作为透析液再循环，而其余部分作为最终滤出液丢弃。采集样本用于测量微量元素、叶酸、氨基酸（AA）、β2-微球蛋白、胱抑素C和肌酐，并计算溶质清除率。
DHF和DHDF对17种AA、磷、叶酸、铜和锌的清除率远低于HVHF，与SVHF相当。SVHF、HVHF、DHF和DHDF的AA估计损失量分别为10.3（7.2 - 13.4）g/d、22.1（17.8 - 24.0）g/d、10.6（8.6 - 14.0）g/d和10.0（8.6 - 11.4）g/d。DHF和DHDF对胱抑素C和β2-微球蛋白的清除率远高于SVHF，与HVHF相当。
与HVHF相比，DHF和DHDF清除大分子溶质的能力相当，但微量营养素损失显著减少。
