Frankenfield D C, Reynolds H N
Department of Clinical Nutrition, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
Nutrition. 1995 Jul-Aug;11(4):388-93.
Continuous arterial-venous and veno-venous hemodiafiltration are reliable methods of renal replacement therapy and are particularly suited to critically ill patients in acute renal failure. Fluid and uremic toxin removal from continuous hemodiafiltration is sufficient to allow unrestricted nutrition support. However, the hemodiafilter cannot discriminate between uremic toxins and nutrients. Therefore, the potential exists for significant nutrient loss during continuous hemodiafiltration. Amino acid loss during continuous hemodiafiltration is approximately 10-15 g/day, although in individual cases > or = 30 g/day can be lost. Neither lipids nor intact proteins are lost to any appreciable degree during continuous hemodiafiltration. Small amounts of glucose are lost if dextrose-free dialysate is used for dialysis. If dextrose-containing dialysate is used, significant amounts of glucose can be absorbed (35-45% of the infused glucose). Fluid replacement with dextrose-containing electrolyte solutions can also lead to significant infusion of glucose. Vitamin and mineral losses during continuous hemodiafiltration are not known; neither are the vitamin requirements for patients receiving continuous hemodiafiltration. Effects of continuous hemodiafiltration on vitamin and mineral loss and status remain an important research question.
持续动静脉血液透析滤过和持续静脉-静脉血液透析滤过是可靠的肾脏替代治疗方法，特别适用于急性肾衰竭的危重症患者。持续血液透析滤过清除液体和尿毒症毒素的能力足以支持不受限制的营养支持。然而，血液透析滤过器无法区分尿毒症毒素和营养物质。因此，在持续血液透析滤过过程中存在大量营养物质丢失的可能性。持续血液透析滤过过程中氨基酸丢失量约为10-15克/天，尽管个别情况下丢失量可能≥30克/天。在持续血液透析滤过过程中，脂质和完整蛋白质均不会出现明显丢失。如果使用无糖透析液进行透析，会有少量葡萄糖丢失。如果使用含糖透析液，大量葡萄糖会被吸收（占输注葡萄糖的35-45%）。用含糖电解质溶液进行液体补充也会导致大量葡萄糖输入。持续血液透析滤过过程中维生素和矿物质的丢失情况尚不清楚；接受持续血液透析滤过治疗的患者的维生素需求也不清楚。持续血液透析滤过对维生素和矿物质丢失及状态的影响仍然是一个重要的研究问题。
