Leypoldt J K, Cheung A K, Deeter R B
Department of Veterans Affairs Medical Center, Department of Internal Medicine, University of Utah, Salt Lake City 84112, USA.
Am J Kidney Dis. 1998 Aug;32(2):295-301. doi: 10.1053/ajkd.1998.v32.pm9708616.
Dialyzers are reused in approximately three quarters of the dialysis units in the United States, but the effect of reprocessing on dialyzer performance has not been extensively evaluated. In a crossover study of six chronic hemodialysis patients, we determined urea, creatinine, phosphate, and beta2-microglobulin clearances and dialysate protein loss for two types of low-flux and two types of high-flux dialyzers during use numbers 1, 2, 5, and 15. Dialyzers were reprocessed by an automated machine using Renalin (Renal Systems, Plymouth, MN) as the germicide. Dialyzer arterial and venous blood and dialysate outflow samples were obtained at 5 and 180 minutes of each dialysis session to evaluate solute clearances. Urea, creatinine, and phosphate clearances were calculated using dialysate concentrations, whereas beta2-microglobulin clearance was calculated using plasma concentrations to include its removal by adsorption to the dialysis membrane. There was a trend for urea, creatinine, and phosphate clearances to decrease with reuse for both low-flux and high-flux dialyzers, but these differences were not statistically significant. The clearance of beta2-microglobulin and dialysate total protein concentration was small for low-flux dialyzers; these values were not dependent on reuse. There was a trend for beta2-microglobulin clearance and dialysate total protein concentration to decrease during a dialysis treatment using high-flux dialyzers. More significantly, beta2-microglobulin clearance and dialysate total protein concentration decreased substantially with the reuse of high-flux dialyzers. These observations show that the maintenance of small solute clearances during reuse of high-flux dialyzers does not ensure the maintenance of large solute clearances.
在美国，约四分之三的透析单位重复使用透析器，但再处理对透析器性能的影响尚未得到广泛评估。在一项针对6名慢性血液透析患者的交叉研究中，我们测定了两种低通量和两种高通量透析器在使用第1次、第2次、第5次和第15次时的尿素、肌酐、磷酸盐和β2-微球蛋白清除率以及透析液蛋白质损失。透析器由一台自动机器使用Renalin（Renal Systems，明尼苏达州普利茅斯）作为杀菌剂进行再处理。在每次透析治疗的5分钟和180分钟时采集透析器动脉和静脉血液以及透析液流出样本，以评估溶质清除率。尿素、肌酐和磷酸盐清除率使用透析液浓度计算，而β2-微球蛋白清除率使用血浆浓度计算，以纳入其通过吸附到透析膜上的清除情况。对于低通量和高通量透析器，尿素、肌酐和磷酸盐清除率都有随重复使用而下降的趋势，但这些差异无统计学意义。低通量透析器的β2-微球蛋白清除率和透析液总蛋白浓度较低；这些值不依赖于重复使用。在使用高通量透析器的透析治疗过程中，β2-微球蛋白清除率和透析液总蛋白浓度有下降趋势。更显著的是，高通量透析器重复使用时，β2-微球蛋白清除率和透析液总蛋白浓度大幅下降。这些观察结果表明，高通量透析器重复使用期间小溶质清除率的维持并不能确保大溶质清除率的维持。
