Department of Internal Medicine, Nephrology Unit, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
Egypt J Immunol. 2023 Jul;30(3):124-133.
Dialysis therapy has remarkably evolved through the innovation in dialyzers and hemodialysis modalities, enhancing patients' quality of life. The efficacy of dialysis can be determined by measuring the reduction ratio (RR) of middle molecules, such as alpha 1-microglobulin (A1M). In this study, we tested a high-flux dialyzer, BIOPURE (Biorema) 260 HF, with a surface area (SA) of 2.6 m2, in terms of A1M removal and concurrent albumin loss in dialysate while receiving high-flux hemodialysis (HF-HD) and post-dilution online hemodiafiltration (OL-HDF). This crossover study comprised 25 patients who received a session of HF-HD using the BIOPURE (Biorema) 260 H, followed by a session of post-dilution OL-HDF. A washout period of 2 weeks was instilled between the two sessions, during which the patients received HF-HD using high-flux dialyzers (maximum SA 2.0 m2). All patients' hourly dialysate albumin and pre/post dialysis concentrations of A1M were measured. The dialyzer used in this study resulted in significantly higher A1M RR of 41.9±7.93% with HDF than with HF-HD 27.12±7.65% (p < 0.001), and a median cumulative dialysate albumin loss of 2.97g (IQR 1.98 - 3.37), and 0.67g (IQR 0.49 - 1.13) with HDF and HF-HD, respectively. In conclusion, the dialyzer BIOPURE (Biorema) 260 HF (SA 2.6 m2) is efficient in eliminating A1M, especially with OL-HDF compared to HF-HD, with acceptable albumin loss in the dialysate.
透析疗法通过透析器和血液透析方式的创新有了显著的发展，提高了患者的生活质量。透析的疗效可以通过测量中分子（如α 1-微球蛋白（A1M））的减少率（RR）来确定。在这项研究中，我们测试了一种高通量透析器 BIOPURE（Biorema）260HF，其表面积（SA）为 2.6m2，在接受高通量血液透析（HF-HD）和后稀释在线血液透析滤过（OL-HDF）时，评估其对 A1M 的清除率和同时在透析液中的白蛋白损失。这项交叉研究包括 25 名患者，他们接受了一次 BIOPURE（Biorema）260HF 的 HF-HD 治疗，随后进行了一次后稀释 OL-HDF 治疗。在两次治疗之间插入了两周的洗脱期，在此期间，患者使用高通量透析器（最大 SA 2.0m2）接受 HF-HD 治疗。所有患者的每小时透析液白蛋白和 A1M 的透析前/后浓度均被测量。本研究中使用的透析器在 HDF 时 A1M 的 RR 明显高于 HF-HD（41.9±7.93%比 27.12±7.65%，p<0.001），且累积透析液白蛋白丢失中位数为 2.97g（IQR 1.98-3.37），与 HF-HD 相比，分别为 0.67g（IQR 0.49-1.13）。结论：与 HF-HD 相比，表面积为 2.6m2 的 BIOPURE（Biorema）260HF 透析器在消除 A1M 方面非常有效，尤其是在进行 OL-HDF 时，同时在透析液中也有可接受的白蛋白丢失。
