Lee Seolhyun, Sirich Tammy L, Meyer Timothy W
The Department of Medicine, Stanford University, Palo Alto, California, USA.
The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA.
Blood Purif. 2022 May 25;51(Suppl 1):1-12. doi: 10.1159/000524512.
The adequacy of hemodialysis is now assessed by measuring the removal of the single-solute urea. The urea clearance provided by contemporary dialysis is a large fraction of the blood flow through the dialyzer and therefore cannot be increased much further. Other solutes however likely contribute more than urea to the residual uremic illness suffered by hemodialysis patients. We here review methods which could be employed to increase the clearance of nonurea solutes. We will separately consider the clearances of free low-molecular-mass solutes, free larger solutes, and protein-bound solutes. New clinical studies will be required to test the extent to which increasing the clearance on nonurea solutes with these various characteristics can improve patients' health.
目前通过测量单溶质尿素的清除率来评估血液透析的充分性。当代透析所提供的尿素清除率在流经透析器的血流量中占很大比例，因此无法进一步大幅提高。然而，其他溶质可能比尿素对血液透析患者残留的尿毒症疾病影响更大。我们在此回顾可用于增加非尿素溶质清除率的方法。我们将分别考虑游离低分子质量溶质、游离大分子溶质和蛋白结合溶质的清除率。需要开展新的临床研究来测试提高具有这些不同特性的非尿素溶质的清除率能在多大程度上改善患者健康。
