Biedunkiewicz Jan, Zakrzewska Agnieszka, Małgorzewicz Sylwia, Komorniczak Michał, Jasiulewicz Katarzyna, Płonka Natalia, Tarasewicz Agnieszka, Jankowska Magdalena, Biedunkiewicz Bogdan, Dębska-Ślizień Alicja, Tylicki Leszek
Department of Anesthesiology and Intensive Therapy, Medical University of Gdansk, Gdańsk, Poland.
Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdańsk, Poland.
Acta Biochim Pol. 2024 Nov 29;71:13715. doi: 10.3389/abp.2024.13715. eCollection 2024.
Various high-efficiency hemodialysis techniques exist, including different online high- volume hemodiafiltration (HDF) modes and expanded hemodialysis (HDx) utilizing dialyzers with medium cut-off (MCO) membranes. This study aimed to evaluate the efficacy of uremic toxin removal among four modalities: (I) HDx, (II) pre-dilution HDF (PRE-HDF), (III) mixed-dilution HDF (MIX-HDF), and (IV) post-dilution HDF (POST-HDF), each applied for 1 week in a randomized order. This research was a single-center, prospective, open-label, exploratory crossover study. The reduction ratio (RR) for small molecular toxins (urea and phosphate), a middle molecular toxin (beta-2-microglobulin, β2M), a large-middle molecular toxin (Chitinase-3-like protein 1, YKL-40), and a protein- bound uremic toxin (indoxyl sulfate, IS) was evaluated during a single mid-week dialysis session. Twelve patients were included, with an average age of 52.5 ± 15.47 years and an average dialysis duration of 42.05 ± 31.04 months. The dialysis parameters, including; post-dialysis weight, session duration, dialysate composition, blood and dialysate flow; rates, dialysate temperature, and anticoagulation dosage, were maintained consistently across all modalities. No significant differences in RR for urea, phosphate, β2M, YKL-40, and IS were observed between the treatments. Although the highest IS clearance, though not statistically significant, was observed with POST-HDF and HDx, the differences were not substantial enough to favor any particular modality as the most effective.
现存在多种高效血液透析技术，包括不同的在线高容量血液透析滤过（HDF）模式以及使用中截留量（MCO）膜透析器的扩展血液透析（HDx）。本研究旨在评估四种模式下尿毒症毒素清除的效果：（I）HDx，（II）前稀释血液透析滤过（PRE - HDF），（III）混合稀释血液透析滤过（MIX - HDF），以及（IV）后稀释血液透析滤过（POST - HDF），每种模式按随机顺序各应用1周。本研究为单中心、前瞻性、开放标签、探索性交叉研究。在一次周中透析过程中评估小分子毒素（尿素和磷酸盐）、中分子毒素（β2微球蛋白，β2M）、大 - 中分子毒素（几丁质酶3样蛋白1，YKL - 40）以及蛋白结合尿毒症毒素（硫酸吲哚酚，IS）的清除率（RR）。纳入12例患者，平均年龄为52.5±15.47岁，平均透析时长为42.05±31.04个月。所有模式下的透析参数，包括透析后体重、治疗时长、透析液成分、血液和透析液流速、透析液温度以及抗凝剂量均保持一致。各治疗组之间在尿素、磷酸盐、β2M、YKL - 40和IS的RR方面未观察到显著差异。尽管后稀释血液透析滤过（POST - HDF）和HDx观察到最高的IS清除率，虽无统计学意义，但差异不足以表明任何一种特定模式是最有效的。
