Ledebo I
Gambro Renal Care, Lund, Sweden.
Int J Artif Organs. 1995 Nov;18(11):735-42.
Postdilution hemofiltration (HF) as practised during the 80's is today associated with limitations of a medical, practical and economical nature. High blood flow rates are required to generate sufficient ultrafiltrate in order to achieve a clearance of small solutes comparable to hemodialysis within a reasonable time. High hematocrit and large body weight lead to extended treatment times. IV-quality solution is required in large volumes. This makes the use of bicarbonate difficult and has placed HF among the most expensive renal replacement therapies. These limitations can be resolved by performing HF in a predilution mode using an on-line prepared infusion solution. Diluting the blood before filtration increases the filtration fraction and the clearance of all solutes which are sieved by the membrane. Comparing pre- to postdilution at similar blood flow rates, the clearance may increase by 50% but three times as much infusion solution is required. To make predilution economically viable, the on-line preparation of the infusion solution is necessary, and this facilitates the use of bicarbonate. Compared to other dialysis therapies this new form of HF offers unequalled solute removal over a large molecular range.
20世纪80年代实施的后稀释血液滤过（HF）如今存在医学、实际操作和经济方面的局限性。为了在合理时间内实现与血液透析相当的小溶质清除率，需要高血流量来产生足够的超滤液。高血细胞比容和大体重会导致治疗时间延长。需要大量静脉注射级别的溶液。这使得使用碳酸氢盐变得困难，并且使血液滤过成为最昂贵的肾脏替代疗法之一。通过使用在线制备的输注溶液以预稀释模式进行血液滤过，可以解决这些局限性。在过滤前稀释血液会增加滤过分数以及被膜筛分的所有溶质的清除率。在相似血流量下比较预稀释和后稀释，清除率可能会提高50%，但所需的输注溶液量会增加两倍。为了使预稀释在经济上可行，必须在线制备输注溶液，这也便于使用碳酸氢盐。与其他透析疗法相比，这种新型血液滤过在大分子范围内提供了无与伦比的溶质清除效果。
