Cheung A K, Agodoa L Y, Daugirdas J T, Depner T A, Gotch F A, Greene T, Levin N W, Leypoldt J K
University of Utah, Salt Lake City, USA.
J Am Soc Nephrol. 1999 Jan;10(1):117-27. doi: 10.1681/ASN.V101117.
Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, performance of reused dialyzers has not been extensively and critically evaluated. The present study analyzes data extracted from a multicenter clinical trial (the HEMO Study) and examines the effect of reuse on urea and beta2-microglobulin (beta2M) clearance by low-flux and high-flux dialyzers reprocessed with various germicides. The dialyzers evaluated contained either modified cellulosic or polysulfone membranes, whereas the germicides examined included peroxyacetic acid/acetic acid/hydrogen peroxide combination (Renalin), bleach in conjunction with formaldehyde, glutaraldehyde or Renalin, and heated citric acid. Clearance of beta2M decreased, remained unchanged, or increased substantially with reuse, depending on both the membrane material and the reprocessing technique. In contrast, urea clearance decreased only slightly (approximately 1 to 2% per 10 reuses), albeit statistically significantly with reuse, regardless of the porosity of the membrane and reprocessing method. Inasmuch as patient survival in the chronic hemodialysis population is influenced by clearances of small solutes and middle molecules, precise knowledge of the membrane material and reprocessing technique is important for the prescription of hemodialysis in centers practicing reuse.
尽管在美国慢性血液透析患者中普遍实行透析器复用，但复用透析器的性能尚未得到广泛而严格的评估。本研究分析了从一项多中心临床试验（血液透析（HEMO）研究）中提取的数据，并研究了复用对使用各种杀菌剂重新处理的低通量和高通量透析器清除尿素和β2-微球蛋白（β2M）的影响。所评估的透析器包含改性纤维素或聚砜膜，而所研究的杀菌剂包括过氧乙酸/乙酸/过氧化氢组合（Renalin）、与甲醛、戊二醛或Renalin联合使用的漂白剂，以及加热的柠檬酸。β2M的清除率随着复用而降低、保持不变或大幅增加，这取决于膜材料和重新处理技术。相比之下，尿素清除率仅略有下降（每复用10次约下降1%至2%），尽管随着复用在统计学上有显著差异，且与膜的孔隙率和重新处理方法无关。由于慢性血液透析人群的患者生存率受小分子和中分子清除率的影响，对于实行复用的中心而言，准确了解膜材料和重新处理技术对于血液透析的处方很重要。
