比较聚甲基丙烯酸甲酯和聚砜透析器膜在肾衰竭患者后稀释血液透析滤过中的清除率：系统评价与Meta分析方案

Comparing Clearances of Polymethylmethacrylate and Polysulfone Dialyzer Membranes for Postdilution Hemodiafiltration in Patients With Kidney Failure: Protocol for a Systematic Review and Meta-Analysis.

作者信息

Ambarsari Cahyani Gita, Kardani Astrid Kristina, Wulandari Agustina, Nadhifah Nadhifah

机构信息

Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia.

School of Medicine, University of Nottingham, Nottingham, United Kingdom.

出版信息

JMIR Res Protoc. 2025 Jun 26;14:e71943. doi: 10.2196/71943.

DOI:10.2196/71943

PMID:40570345

Abstract

BACKGROUND

Kidney replacement therapy (KRT) is needed by patients with kidney failure to eliminate metabolic waste. When kidney transplantation is not feasible, hemodialysis (HD) is performed. Hemodiafiltration (HDF) provides a better solute clearance than conventional HD due to its higher convective dose. The clearance performances of HDF also depend on the type of dialysis membrane used. Polysulfone (PS) membranes have been used since 1965 due to their excellent resistance and biocompatibility. However, the newer generation of polymethylmethacrylate (PMMA) membranes offers comparable convective capacity with reduced albumin loss.

OBJECTIVE

The forthcoming study aims to compare the solute clearance of postdilution HDF using PMMA versus PS dialyzer membranes in patients with kidney failure requiring long-term HD.

METHODS

The literature search will use databases including PubMed, Scopus, Web of Science, Embase, and Cochrane. Two independent reviewers will select studies and assess their quality. Pooled estimates of relevant factors will be computed via a random-effects model using Stata/BE 18 (StataCorp) software. The reporting of findings will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

The search and screening for the systematic literature review are expected to be completed in May 2026. Data extraction, quality appraisal, and subsequent data synthesis will begin in June 2026. The review should be completed by October 2026, and the study results will be published in 2027.

CONCLUSIONS

Dialyzer membrane clearance determines HD quality. Nevertheless, many middle uremic molecules are poorly cleared with conventional HD. Consequently, HDF was invented to improve their clearance. Among the most widely used dialyzer membranes, PS and PMMA are used in the newer generation of HDF. Nevertheless, no available systematic reviews have compared the efficacy of the 2 dialyzer membrane materials. Although no ideal dialyzer can efficiently remove all types of uremic toxins while retaining essential elements, improving solute clearance should benefit patients. This information could help clinicians determine which membrane to use in HDF.

TRIAL REGISTRATION

PROSPERO CRD42024603277; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024603277.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/71943.

摘要

背景

肾衰竭患者需要进行肾脏替代治疗（KRT）以清除代谢废物。当肾脏移植不可行时，会进行血液透析（HD）。血液透析滤过（HDF）由于其较高的对流剂量，比传统HD能提供更好的溶质清除率。HDF的清除性能也取决于所使用的透析膜类型。聚砜（PS）膜自1965年以来就因其出色的耐受性和生物相容性而被使用。然而，新一代的聚甲基丙烯酸甲酯（PMMA）膜具有相当的对流能力，同时白蛋白损失减少。

目的

即将开展的研究旨在比较在需要长期HD的肾衰竭患者中，使用PMMA透析器膜与PS透析器膜进行后置稀释HDF的溶质清除情况。

方法

文献检索将使用包括PubMed、Scopus、Web of Science、Embase和Cochrane在内的数据库。两名独立的评审员将选择研究并评估其质量。相关因素的合并估计值将使用Stata/BE 18（StataCorp）软件通过随机效应模型进行计算。研究结果的报告将遵循PRISMA（系统评价和Meta分析的首选报告项目）指南。

结果

系统性文献综述的检索和筛选预计于2026年5月完成。数据提取、质量评估及后续的数据合成将于2026年6月开始。综述应于2026年10月完成，研究结果将于2027年发表。

结论

透析器膜的清除率决定了HD的质量。然而，许多中分子尿毒症毒素用传统HD难以清除。因此，发明了HDF以改善其清除效果。在最广泛使用的透析器膜中，PS和PMMA用于新一代的HDF。然而，尚无可用的系统性综述比较这两种透析器膜材料的疗效。尽管没有理想的透析器能在保留必需成分的同时有效清除所有类型的尿毒症毒素，但提高溶质清除率应会使患者受益。这些信息可帮助临床医生确定在HDF中使用哪种膜。