使用中分子截留型透析器行短频血液透析清除中分子物质。

Removal of middle molecules with medium cutoff dialyzer in patients on short frequent hemodialysis.

机构信息

Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.

Department of Nephrology, Clínica de Doenças Renais de Brasília, Brasília, Brazil.

出版信息

Hemodial Int. 2021 Apr;25(2):180-187. doi: 10.1111/hdi.12906. Epub 2020 Nov 22.

DOI:10.1111/hdi.12906

PMID:33225535

Abstract

INTRODUCTION

Medium cutoff (MCO) membranes for hemodialysis (HD) remove more effectively large middle molecules than high-flux (HF) membranes. In patients on in-center short frequent HD regimen (5 sessions per week, 2 hours and 30 minutes per session) the effect of MCO on middle weight uremic toxins has not been elucidated.

METHODS

This retrospective study included 15 patients previously performing short frequent HD with HF dialyzer (HF-HD), that were switched to short frequent HD with MCO dialyzer (MCO-HD) for 2 months, and returned to HF-HD. The primary endpoint was the predialysis concentration of α1-acid glycoprotein during the different study phases. Secondary endpoints were predialysis concentration of other middle molecules, albumin, and assessment of the quality of life using the 36-item short-form health survey (SF-36).

FINDINGS

During MCO-HD phase there was a reduction in mean ± SD α1-acid glycoprotein concentration (98.71 ± 25.2 vs. 88.6 ± 24.6 mg/dL, P = 0.107), followed by an increment 2 months after returning to HF-HD (89.18 ± 26.12 vs. 97.33 ± 31.29 mg/dL, P = 0.002); however, only the second variation was statistically significant. MCO-HD provided lower median predialysis concentration of prolactin (16 [10.2-25.6] vs. 14.1 [11.7-34.8] ng/mL, P = 0.036). Single-pool Kt/V, standard Kt/V, predialysis β2-microglobulin, myoglobin, and SF-36 questionnaire remained stable during the first two phases (pre-MCO and MCO). β2-Microglobulin increased in the post-MCO phase (20.02 ± 8.14 vs. 21.27 ± 7.64 μg/mL, P = 0.000). Mean predialysis concentration of albumin reduced significantly from pre-MCO vs. MCO phases (39.9 ± 3.7 vs. 38.3 ± 3.3 g/L, P = 0.020) and rebounded significantly from MCO vs. post-MCO phases (38.7 ± 3.1 vs. 41.3 ± 3.0 g/L, P = 0.007).

DISCUSSION

In this retrospective analysis, short frequent MCO-HD promotes a reduction in prolactin, a middle weight uremic toxin, and trends toward a reduction in α1-acid glycoprotein. No patients developed hypoalbuminemia. These findings are encouraging and deserve investigation in prospective studies.

摘要

简介

与高通量（HF）膜相比，中截留（MCO）膜在血液透析（HD）中更有效地清除大中分子量物质。在接受中心短频 HD 方案（每周 5 次，每次 2 小时 30 分钟）的患者中，MCO 对中分子量尿毒症毒素的影响尚未阐明。

方法

本回顾性研究纳入了 15 例先前接受 HF 透析器（HF-HD）短频 HD 的患者，他们切换至 MCO 透析器（MCO-HD）进行 2 个月的短频 HD，然后转回 HF-HD。主要终点是不同研究阶段时的透析前 α1-酸性糖蛋白浓度。次要终点是其他中分子量物质、白蛋白的透析前浓度，以及使用 36 项简短健康调查问卷（SF-36）评估生活质量。

结果

在 MCO-HD 阶段，α1-酸性糖蛋白的平均浓度（±标准差）降低（98.71±25.2 对 88.6±24.6 mg/dL，P=0.107），2 个月后返回 HF-HD 时升高（89.18±26.12 对 97.33±31.29 mg/dL，P=0.002）；然而，只有第二次变化具有统计学意义。MCO-HD 提供了更低的中位数催乳素透析前浓度（16 [10.2-25.6] 对 14.1 [11.7-34.8] ng/mL，P=0.036）。在第一和第二阶段（MCO 前和 MCO），单池 Kt/V、标准 Kt/V、透析前β2-微球蛋白、肌红蛋白和 SF-36 问卷保持稳定。β2-微球蛋白在 MCO 后阶段增加（20.02±8.14 对 21.27±7.64 μg/mL，P=0.000）。白蛋白的平均透析前浓度从 MCO 前阶段显著降低（39.9±3.7 对 38.3±3.3 g/L，P=0.020），并从 MCO 阶段显著反弹（38.7±3.1 对 41.3±3.0 g/L，P=0.007）。