高通量与高起始截留率膜：在对流透析模式下小分子和中分子的体内动力学。

High-Flux versus High-Retention-Onset Membranes: In vivo Small and Middle Molecules Kinetics in Convective Dialysis Modalities.

机构信息

Renal Division, Department of Medicine, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.

Nephrology Division, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.

出版信息

Blood Purif. 2020;49(1-2):8-15. doi: 10.1159/000502082. Epub 2019 Jul 30.

DOI:10.1159/000502082

PMID:31362299

Abstract

BACKGROUND

Patients undergoing maintenance hemodialysis (HD) exhibit increased levels of uremic toxins, which are associated with poor outcomes. Recently, new dialysis membranes have allowed clearance of solutes with higher molecular weight, without significant albumin losses high-retention-onset-HD (HRO-HD).

METHODS

Prospective crossover trial, in which 16 prevalent patients switched from high-flux HD (HF-HD) to online hemodiafiltration (olHDF) and HRO-HD for 4 weeks. The following variables were evaluated: pre- and post-dialysis serum concentrations of albumin, urea, phosphate (P), beta-2 microglobulin (β2M), and total mass (TM) extraction and dialyzer clearance of urea, P, and β2M.

RESULTS

Comparing HF-HD, olHDF, and HRO-HD, respectively, there were no differences regarding pre-dialysis serum concentrations of albumin (3.94 ± 0.36, 4.06 ± 0.22, and 3.93 ± 0.41 g/dL, p = 0.495), urea (166 ± 29, 167 ± 30, and 164 ± 27 mg/dL, p = 0.971), P (4.9 ± 2.1, 5.2 ± 1.6, and 4.9 ± 2.1 mg/dL, p = 0.879), and β2M (31.3 ± 7.1, 32.6 ± 8.6, and 33.7 ± 5.9 µg/mL, p = 0.646). β2M clearance was significantly lower in HF-HD in comparison to both olHDF and HRO-HD: 43 (37-53) versus 64 (48-85) mL/min, p = 0.013, and 69 (58-86) mL/min, p = 0.015, respectively. Post-dialysis β2M serum concentration was higher in HF-HD in comparison to olHDF and HRO-HD: 11.6 (9.6-12.4) vs. 5.7 (4.5-7.0) µg/mL, p = 0.001, and 5.6 (5.3-7.6) µg/mL, p = 0.001, respectively. TM extraction of urea, P, and β2M were similar across the 3 dialysis modalities.

CONCLUSIONS

olHDF and HRO-HD were superior to HF-HD regarding β2M clearance, leading to lower post-dialysis β2M levels.

摘要

背景

接受维持性血液透析（HD）的患者表现出更高水平的尿毒症毒素，这与不良结局相关。最近，新型透析膜允许清除更高分子量的溶质，而不会导致白蛋白大量丢失（高保留起始 HD [HRO-HD]）。

方法

前瞻性交叉试验，其中 16 例持续性患者从高通量 HD（HF-HD）切换至在线血液透析滤过（olHDF）和 HRO-HD 治疗 4 周。评估了以下变量：透析前和透析后血清白蛋白、尿素、磷酸盐（P）、β2 微球蛋白（β2M）浓度和尿素、P 和 β2M 的透析器清除率。

结果

与 HF-HD 相比，olHDF 和 HRO-HD 的透析前血清白蛋白浓度分别为（3.94 ± 0.36、4.06 ± 0.22 和 3.93 ± 0.41 g/dL，p = 0.495）、尿素（166 ± 29、167 ± 30 和 164 ± 27 mg/dL，p = 0.971）、P（4.9 ± 2.1、5.2 ± 1.6 和 4.9 ± 2.1 mg/dL，p = 0.879）和β2M（31.3 ± 7.1、32.6 ± 8.6 和 33.7 ± 5.9 µg/mL，p = 0.646）没有差异。与 olHDF 和 HRO-HD 相比，HF-HD 中的 β2M 清除率显著降低：43（37-53）vs. 64（48-85）mL/min，p = 0.013 和 69（58-86）mL/min，p = 0.015。与 olHDF 和 HRO-HD 相比，HF-HD 中的透析后β2M 血清浓度更高：11.6（9.6-12.4）vs. 5.7（4.5-7.0）µg/mL，p = 0.001 和 5.6（5.3-7.6）µg/mL，p = 0.001。3 种透析方式的尿素、P 和 β2M 的总质量提取相似。