Kikuchi F, Kuno T, Nagura Y, Takahashi S, Kanmatsuse K
2nd Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 1998 May;40(4):258-62.
Seven patients undergoing chronic hemodialysis three times a week and whose plasma bicarbonate concentration on predialysis was consistently under 18 mmol/l due to bicarbonate dialysis (BCD), were treated with BCD for 2 weeks, then switched to acetate-free biofiltration (AFB) for 8 weeks. In both periods, the same high flux dialyzer (AN69HF) was used. The treatment time, dialysate flow rate and blood flow rate were kept constant in each patient during both periods. Plasma bicarbonate concentration (HCO3-), serum urea nitrogen (SUN), serum creatinine (Cr) and plasma amino acids concentrations (AA) were measured before dialysis and KT/V was calculated on the 2nd days of the last week in both periods. HCO3- on AFB was significantly higher than that on BCD (16.4 +/- 0.9 vs 19.9 +/- 1.8 mmol/l; p < 0.05). SUN on AFB was significantly lower than that on BCD even though the dialysis schedule and dietary content were not changed (84.7 +/- 3.7 vs 76.6 +/- 3.8 mg/dl; p < 0.05). TP, Cr and KT/V were not significantly different. Plasma total amino acid concentration (TAA) and plasma essential amino acid concentration (EAA) were not significantly different in both periods. In contrast, plasma branched-chain amino acid concentrations (BCAA) on AFB were significantly higher than that on BCD (313.5 +/- 44.3 vs 390.3 +/- 50.7 mumol/l; p < 0.05). Plasma BCAA concentrations, valine (VAL), leucine (LEU) and isoleucine (ILE), were significantly higher on AFB than that on BCD, respectively (p < 0.05). These findings suggest that optimal correction of the metabolic acidosis in chronic hemodialysis patients by AFB leads to a significant increase in plasma BCAA concentration.
7例每周进行3次慢性血液透析的患者，因碳酸氢盐透析（BCD）导致透析前血浆碳酸氢盐浓度持续低于18 mmol/L，先接受2周的BCD治疗，然后改用无醋酸盐生物滤过（AFB）治疗8周。在两个阶段均使用同一高通量透析器（AN69HF）。两个阶段中，每位患者的治疗时间、透析液流速和血流量均保持恒定。在透析前测量血浆碳酸氢盐浓度（HCO3-）、血清尿素氮（SUN）、血清肌酐（Cr）和血浆氨基酸浓度（AA），并在两个阶段最后一周的第2天计算KT/V。AFB治疗时的HCO3-显著高于BCD治疗时（16.4±0.9 vs 19.9±1.8 mmol/L；p<0.05）。即使透析方案和饮食内容未改变，AFB治疗时的SUN也显著低于BCD治疗时（84.7±3.7 vs 76.6±3.8 mg/dl；p<0.05）。总蛋白（TP）、Cr和KT/V无显著差异。两个阶段的血浆总氨基酸浓度（TAA）和血浆必需氨基酸浓度（EAA）无显著差异。相反，AFB治疗时的血浆支链氨基酸浓度（BCAA）显著高于BCD治疗时（313.5±44.3 vs 390.3±50.7 μmol/L；p<0.05）。AFB治疗时血浆BCAA浓度、缬氨酸（VAL）、亮氨酸（LEU）和异亮氨酸（ILE）分别显著高于BCD治疗时（p<0.05）。这些发现表明，AFB对慢性血液透析患者代谢性酸中毒的最佳纠正导致血浆BCAA浓度显著升高。
