Universidade de Brasília, Faculdade de Ciências da Saúde, Laboratório de Farmacologia Molecular, Brasília, DF, Brasil.
San Bortolo Hospital, International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy.
J Bras Nefrol. 2021 Jul-Sep;43(3):410-416. doi: 10.1590/21758239-JBN-2020-0273.
In the past decade, a new class of hemodialysis (HD) membranes (high retention onset class) became available for clinical use. The high cutoff (HCO) and the medium cutoff (MCO) membranes have wider pores and more uniformity in pore size, allowing an increased clearance of uremic toxins. Owing to the mechanism of backfiltration/internal filtration, middle molecules are dragged by the convective forces, and no substitution solution is needed. The HCO dialyzer is applied in septic patients with acute kidney injury requiring continuous kidney replacement therapy. The immune response is modulated thanks to the removal of inflammatory mediators. Another current application for the HCO dialyzer is in hematology, for patients on HD secondary to myeloma-kidney, since free light chains are more efficiently removed with the HCO membrane, reducing their deleterious effect on the renal tubules. In its turn, the MCO dialyzer is used for maintenance HD patients. A myriad of clinical trials published in the last three years consistently demonstrates the ability of this membrane to remove uremic toxins more efficiently than the high-flux membrane, an evolutionary disruption in the HD standard of care. Safety concerns regarding albumin loss as well as blood contamination from pyrogens in the dialysate have been overcome. In this update article, we explore the rise of new dialysis membranes in the light of the scientific evidence that supports their use in clinical practice.
在过去的十年中，一类新型的血液透析（HD）膜（高截留起始类）已可用于临床应用。高通量（HCO）和中通量（MCO）膜具有更大的孔径和更均匀的孔径分布，可提高尿毒症毒素的清除率。由于反向过滤/内过滤的机制，中分子被对流力拖曳，因此不需要替代溶液。HCO 透析器应用于需要连续肾脏替代治疗的急性肾损伤的脓毒症患者。由于清除了炎症介质，免疫反应得到了调节。HCO 透析器的另一个当前应用是血液学，用于因骨髓瘤肾脏而接受 HD 的患者，因为 HCO 膜可更有效地清除游离轻链，从而减少其对肾小管的有害影响。反过来，MCO 透析器用于维持性 HD 患者。过去三年发表的大量临床试验一致表明，与高通量膜相比，这种膜能够更有效地清除尿毒症毒素，这是 HD 护理标准的一个重大进步。关于白蛋白损失和透析液中内毒素引起的血液污染的安全问题已经得到解决。在这篇更新的文章中，我们根据支持其在临床实践中应用的科学证据，探讨了新型透析膜的出现。
