Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Nephrology School, Milano-Bicocca University, Milan, Italy.
Blood Purif. 2019;48(1):86-96. doi: 10.1159/000499830. Epub 2019 May 3.
NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this "low dialysate volumes system" on the removal rate of poorly diffusible, time-dependent solutes like β2-microglobulin (β2M).
Single-session and weekly balances of β2M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD).
Intradialytic fall of plasma water β2M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD.
Weekly β2M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.
NxStage System One （NSO） 是一种广泛应用于家庭日常透析的系统。关于这种“低透析液量系统”对β2-微球蛋白（β2M）等扩散性差、时间依赖性溶质的清除率的影响，数据有限。
对 12 名接受每日 NSO 治疗的患者、13 名接受标准高流量碳酸氢盐透析（BHD）的患者、5 名接受标准在线血液透析滤过（HDF）后稀释的患者和 13 名接受自动腹膜透析（APD）的患者进行单次治疗和每周β2M 平衡评估。
HDF、BHD 和 NSO 中，血液透析过程中血浆水β2M 水平（校正反弹后）下降率分别为 65.2 ± 2.6%、49.8 ± 9.1%和 32.3 ± 6.4%（各组间差异均<0.001）。APD 的单次治疗透析液清除量（19.4 ± 20.4 mg）明显少于任何体外技术（均<0.001），也少于 NSO（126.2 ± 35.6 mg，均<0.001）和 BHD（204.9 ± 53.4 mg）和 HDF（181.9 ± 37.6 mg），后两者之间差异无统计学意义；然而，NSO 的每周清除率（757.3 ± 213.7 mg）高于 BHD（614.8 ± 160.3 mg）和 HDF（545.8 ± 112.8 mg）。BHD 中β2M 对膜的吸附可忽略不计，HDF 和 NSO 中总清除率的 14.7 ± 9.5%和 18.3 ± 18.5%。将单次治疗数据整合到每周效率指标（K×t）中显示，NSO 中清除的血浆总量（33.4 ± 7.7 L/周）高于 BHD（26.9 ± 7.2 L/周，p<0.01），与 HDF （36.2 ± 4.7 L/周）相同；APD 中可忽略不计（3.2 ± 1.0）。
每周β2M 清除效率在 HDF 和 NSO 中相同且最高（每周 6 次处方），在 BHD 中略低，在 APD 中最低。
