Therapeutic effects of the long-term use of PAN membrane dialyzer in hemodialysis patients: efficacy in old dialysis patients with mild PAD.
Therapeutic effects of the long-term use of PAN membrane dialyzer in hemodialysis patients: efficacy in old dialysis patients with mild PAD.
复制标题
血液透析患者长期使用PAN膜透析器的治疗效果：对老年轻度PAD透析患者的疗效
DOI：
--
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Y. Katayama
中科院分区：
文献类型：
--
作者：
Hiroaki Nakada;T. Kashiwagi;Y. Iino;Y. Katayama
背景
据报道，AN69 透析器是一种带有聚丙烯腈膜（PAN 膜）的板式透析器，可减轻血液透析（HD）患者的营养状况不良和外周动脉疾病（PAD）等并发症的症状。然而，很少有研究调查 PAN 膜的长期使用，或将 PAN 膜与最广泛使用的透析膜 IV 型聚砜膜（PS 膜）的溶质去除性能进行比较。在本研究中，我们比较了AN69膜透析器与IV型PS膜透析器的污染物去除性能，并研究了长期使用前者对患有轻度PAD的老年血液透析患者的临床效果。
方法
对 6 名患者进行了间隔 2 周的溶质交叉试验，以比较膜去除小分子量物质、β2 微球蛋白 (β2MG)、氨基酸 (AA) 和血清白蛋白 (Alb) 的性能。接下来，8 名患者使用 AN69 膜进行为期 72 周的透析。观察白蛋白的时程变化、老年营养风险指数（GNRI）、肌酐生成率（%CGR）、标准化蛋白质分解代谢率（nPCR）和干重（DW）以评估营养状况。观察β2MG、C反应蛋白（CRP）、低密度脂蛋白胆固醇（LDL）、纤维蛋白原（Fib）、氮氧化物（NOx）、血红蛋白（Hb）、铁蛋白、转铁蛋白饱和度（TSAT）、促红细胞生成剂（ESA）剂量、铁剂剂量的时程变化，评价长期用药的疗效。在两个点测量皮肤灌注压 (SPP)：一次在转换为 AN69 膜时测量，一次在 72 周后测量。
结果
在交叉试验中，AN69膜在去除小分子量物质方面表现出与PS膜基本相同的透析效率，但其去除量明显较低的β2MG。 AN69 膜还表现出显着较低的 AA 去除率和 Alb 泄漏率。改用AN69膜后，长期使用过程中营养状况保持稳定，β2MG未见明显升高。 Fib 和 NOx 均减少，后者的程度显着。 Hb 值显示出良好的时间进程，TSAT 水平相对较高，铁蛋白水平总体较低。 SPP 在 72 周内基本保持稳定。
结论
交叉试验表明，与 PS 膜相比，AN69 膜消除的 AA 和 Alb 较少。从长期使用AN69膜的治疗效果来看，该膜在老年HD轻度PAD患者的治疗中具有良好的透析效果，且具有良好的生物相容性。
BACKGROUND
AN69 dialyzer, a plate type dialyzer with a polyacrylonitrile membrane (PAN membrane) is reported to reduce symptoms in hemodialysis (HD) patients with complications such as poor nutritional status and peripheral arterial disease (PAD). Yet very few studies have investigated the long-term use of the PAN membrane or compared the solute-removal properties of the PAN membrane with those of the Type IV polysulfone membrane (PS membrane), the dialysis membrane most widely used. In the present study we compared the contaminant-removal properties of the AN69 membrane dialyzer with those of a Type IV PS membrane dialyzer and investigated the clinical effects of the long-term use of the former for elderly hemodialysis patients with mild PAD.
METHODS
Cross-over trials with 2 week intervals for solute were conducted in 6 patients to compare the performance of the membranes in removing small molecular weight substances, β2 microglobulin (β2MG), amino acid (AA), and serum albumin (Alb). Next, the AN69 membrane was used for dialysis over a period of 72 weeks in 8 patients. The time course changes of Alb, the geriatric nutritional risk index (GNRI), the % creatinine generation rate (%CGR), the normalized protein catabolic rate (nPCR) and the dry weight (DW) were observed to evaluate the nutritional status. The time course changes of β2MG, C-reactive proteins (CRP), LDL cholesterol (LDL), fibrinogens (Fib), nitrogen oxide (NOx), hemoglobin (Hb), ferritins, transferrin saturation (TSAT), dose of erythropoiesis-stimulating agents (ESA), and dose of iron were observed to evaluate the therapeutic effects of long-term use. Skin perfusion pressure (SPP) was measured at two points: once at the switchover to the AN69 membrane and once 72 weeks later.
RESULTS
In cross-over trials, the AN69 membrane showed basically the same dialysis efficiency as the PS membrane in removing small molecular weight substances, but it removed significantly lower amounts of β2MG. The AN69 membrane also showed significantly lower rates of AA removal rate and Alb leakage. The nutritional status was stably maintained during long-term use after the switchover to the AN69 membrane, and no significant increase of β2MG was observed. Fib and NOx were both reduced, the latter to a significant degree. The Hb values showed a good time course, with relatively high TSAT levels and low ferritin levels overall. SPP remained generally stable for 72 weeks.
CONCLUSION
The cross-over trial show the AN69 membrane eliminates less AA and Alb compared with the PS membrane. Judging from the therapeutic effects of the long-term use of the AN69 membrane, the membrane is effective for dialysis and has good biocompatibility in the treatment of elderly HD patients with mild PAD.
DOI：
10.1016/0006-291x(85)91948-5
发表时间：
1985-01-01
影响因子：
3.1
作者：
GEJYO, F;YAMADA, T;SCHMID, K
通讯作者：
SCHMID, K