透析膜在急性肾衰竭患者治疗中的作用。

Effect of the dialysis membrane in the treatment of patients with acute renal failure.

作者信息

Hakim R M, Wingard R L, Parker R A

机构信息

Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

出版信息

N Engl J Med. 1994 Nov 17;331(20):1338-42. doi: 10.1056/NEJM199411173312003.

DOI:10.1056/NEJM199411173312003

PMID:7935703

Abstract

BACKGROUND

The mortality rate among patients with acute renal failure remains high, and the role of the biocompatibility of the dialysis membrane in the resolution of this disorder is not known.

METHODS

We prospectively studied 72 patients with acute renal failure who required hemodialysis and assigned them to two treatment groups. One group underwent dialysis with the widely used cuprophane dialysis membrane, which activates the complement system and leukocytes, and the other group underwent dialysis with a synthetic polymethyl methacrylate membrane, which has a more limited effect on complement and leukocytes. Scores on the Acute Physiology, Age, and Chronic Health Evaluation (APACHE II) were calculated at the initiation of dialysis. Survival and the recovery of renal function were determined with the use of proportional-hazards and exact logistic-regression analyses.

RESULTS

When dialysis was initiated, the patients in the two groups were similar in terms of age, APACHE II scores, the prevalence of oliguria, and biochemical indexes of renal failure. Twenty-three of the 37 patients (62 percent) in the group undergoing dialysis with the polymethyl methacrylate membrane recovered renal function, as compared with 13 of the 35 patients (37 percent) in the group undergoing dialysis with the cuprophane membrane (P = 0.04 after adjustment for the APACHE II score). The median number of dialysis treatments required before the recovery of renal function was 5 in the former group and 17 in the latter group (P = 0.02). Twenty-one patients (57 percent) undergoing dialysis with the polymethyl methacrylate membrane survived, as compared with 13 patients (37 percent) undergoing dialysis with the cuprophane membrane (P = 0.11). Of the 20 patients in each group who initially had nonoliguric acute renal failure, the survival rates were 80 percent with the polymethyl methacrylate membrane and 40 percent with the cuprophane membrane (P = 0.01).

CONCLUSIONS

Among patients with acute renal failure requiring hemodialysis, the use of the polymethyl methacrylate membrane, as compared with the cuprophane membrane, resulted in improved recovery of renal function.

摘要

背景

急性肾衰竭患者的死亡率仍然很高，透析膜的生物相容性在解决这一病症中的作用尚不清楚。

方法

我们前瞻性地研究了72例需要血液透析的急性肾衰竭患者，并将他们分为两个治疗组。一组使用广泛应用的铜仿透析膜进行透析，该膜会激活补体系统和白细胞；另一组使用合成的聚甲基丙烯酸甲酯膜进行透析，该膜对补体和白细胞的影响较小。在开始透析时计算急性生理学与慢性健康状况评分系统（APACHE II）得分。使用比例风险分析和精确逻辑回归分析来确定生存率和肾功能恢复情况。

结果

开始透析时，两组患者在年龄、APACHE II评分、少尿的发生率以及肾衰竭的生化指标方面相似。聚甲基丙烯酸甲酯膜透析组的37例患者中有23例（62%）肾功能恢复，而铜仿膜透析组的35例患者中有13例（37%）肾功能恢复（校正APACHE II评分后P = 0.04）。肾功能恢复前所需透析治疗的中位数，前一组为5次，后一组为17次（P = 0.02）。聚甲基丙烯酸甲酯膜透析组有21例患者（57%）存活，而铜仿膜透析组有13例患者（37%）存活（P = 0.11）。每组最初患有非少尿型急性肾衰竭的20例患者中，聚甲基丙烯酸甲酯膜组的生存率为80%，铜仿膜组为40%（P = 0.01）。