de Francisco A L, Botella J, Escallada R, Hernandez J, Martin Malo A, Perez Garcia R, Sanchez Tomero J A, Sanz C
Servicio de Nefrologia, Hospital Universitario Valdecilla, Santander, Spain.
Nephrol Dial Transplant. 1997 Mar;12(3):528-34. doi: 10.1093/ndt/12.3.528.
Uncoated adsorbent charcoal may regenerate the ultrafiltrate suggesting its use as an endogenous substitution fluid. The objective of this study was to assess the safety and the long-term clinical results.
Thirty-three chronic uraemic patients were dialysed for 1 year using two haemodialysers in series in order to separate convection from diffusion. At the outflow of the convective haemofilter, a cartridge containing 130 g of uncoated charcoal was inserted. The regenerated ultrafiltrate was then infused at the entrance of the diffusive dialyser. Ex vivo and in vitro studies were performed to analyse the adsorption characteristics and the release of aluminium, other trace elements, and microparticles.
Passage through the charcoal left urea, phosphate, potassium, calcium, and bicarbonate concentrations unchanged. Creatinine, uric acid and beta 2-microglobulin were almost completely absorbed by the charcoal. Aluminium release was dependent upon time of storage, as inferred from studies on inter-lot variability. Washing with bicarbonate buffer (pH 7.0) allowed reduction of aluminium levels to within the pharmacopoeia requirements for intravenous fluids. No significant pre- or post-charcoal differences were observed for several trace elements such as manganese, selenium, arsenic, cadmium, mercury, lead, chromium and zinc. Copper was completely retained in the charcoal. Regenerated ultrafiltrate infused at the entrance of the diffusive dialyser was free of microparticles, bacteria, and endotoxin. Clinical tolerance was excellent and blood pressure control satisfactory. A significant decrease in serum values of beta 2-microglobulin was observed at 6 and 12 months of treatment.
Reinfusion of ultrafiltrate through an uncoated charcoal cartridge proved to be a safe, well-tolerated and simple technique. Further potential benefits of regenerated ultrafiltrate may also include the maintenance of acid-base balance with reinfusion of endogenous bicarbonate.
未包膜的吸附性活性炭可能使超滤液再生，这表明其可用作内源性置换液。本研究的目的是评估其安全性和长期临床效果。
33例慢性尿毒症患者使用串联的两个血液透析器进行了1年的透析，以便将对流与扩散分开。在对流血液滤过器的流出端，插入一个装有130克未包膜活性炭的滤筒。然后将再生的超滤液注入扩散透析器的入口处。进行了体外和体内研究，以分析铝、其他微量元素和微粒的吸附特性及释放情况。
通过活性炭后，尿素、磷酸盐、钾、钙和碳酸氢盐的浓度未发生变化。肌酐、尿酸和β2-微球蛋白几乎被活性炭完全吸附。根据批次间变异性研究推断，铝的释放取决于储存时间。用碳酸氢盐缓冲液（pH 7.0）冲洗可使铝含量降低至静脉输液的药典要求范围内。对于锰、硒、砷、镉、汞、铅、铬和锌等几种微量元素，未观察到活性炭处理前后有显著差异。铜完全保留在活性炭中。注入扩散透析器入口处的再生超滤液不含微粒、细菌和内毒素。临床耐受性良好，血压控制令人满意。在治疗6个月和12个月时，观察到血清β2-微球蛋白值显著下降。
通过未包膜活性炭滤筒回输超滤液被证明是一种安全、耐受性良好且简单的技术。再生超滤液的进一步潜在益处可能还包括通过回输内源性碳酸氢盐维持酸碱平衡。
