Department of Nephrology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Toxins (Basel). 2021 Mar 29;13(4):244. doi: 10.3390/toxins13040244.
The aim of this systematic review is to investigate the effects of the use of a medium cut-off membrane (MCO) and dietary fiber on the concentration of protein-bound uremic toxins (PBUTs) and inflammatory markers in hemodialysis (HD) patients. Of 11,397 papers originally found, eight met the criteria of randomized controlled trial design. No study examined the effects of MCO membranes on PBUTs. Three studies examined the reduction in inflammatory markers with MCO membranes compared to high-flux HD membranes and showed no significant differences. Five studies of dietary fiber supplementation showed an inconclusive positive effect on PBUT levels and a significant positive effect on the reduction in inflammatory markers (interleukin-6 reduction: standardized difference in means -1.18; 95% confidence interval -1.45 to -0.9 for dietary fiber supplementation vs. control; < 0.001). To date, no study has combined the use of an MCO membrane and fiber supplementation to reduce PBUT levels and inflammation with online hemodiafiltration as a comparator. A rationale and protocol for an interventional trial using a combination of MCO membrane dialysis and fiber supplementation to lower inflammatory markers and PBUT concentrations are presented.
本系统评价的目的是调查使用中分子量截留膜（MCO）和膳食纤维对血液透析（HD）患者蛋白结合尿毒症毒素（PBUT）和炎症标志物浓度的影响。在最初发现的 11397 篇论文中，有 8 篇符合随机对照试验设计的标准。没有研究考察 MCO 膜对 PBUT 的影响。三项研究考察了 MCO 膜与高通量 HD 膜相比对炎症标志物的降低作用，结果显示无显著差异。五项膳食纤维补充研究显示对 PBUT 水平有不确定的积极影响，并对炎症标志物的降低有显著的积极影响（白细胞介素-6 降低：膳食纤维补充与对照组相比的标准化均数差 -1.18；95%置信区间 -1.45 至 -0.9；<0.001）。迄今为止，没有研究将 MCO 膜与纤维补充联合使用，并用在线血液透析滤过作为对照来降低 PBUT 水平和炎症。提出了一项使用 MCO 膜透析和纤维补充联合降低炎症标志物和 PBUT 浓度的干预性试验的原理和方案。
