Validity of Internal Filtration-Enhanced Hemodialysis as a New Hemodiafiltration Therapy
Validity of Internal Filtration-Enhanced Hemodialysis as a New Hemodiafiltration Therapy
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DOI：
10.1159/000167006
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发表时间：
2009-01-01
影响因子：
3
通讯作者：
Sakiyama, Ryoichi
中科院分区：
文献类型：
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作者：
Mineshima, Michio;Ishimori, Isamu;Sakiyama, Ryoichi
为了提高溶质的去除效率，介绍了几种具有增强型内滤(IF)的透析器的临床应用。在这些透析器中，除了扩散传输外，还增强了溶质的对流传输。内滤过增强型血液透析(IFEHD)被定义为使用增强型IF透析器的血液透析治疗，与传统的血液透析滤过疗法相比，似乎更方便，因为没有额外的设备，如滚柱泵。本文在几种类型的实验研究中检验了IFEHD的有效性。因此，几种增强型IF透析器的实验研究表明，与传统透析器相比，水溶液中的相对溶质清除值高于1。肌红蛋白作为一个较大的分子所获得的K值是前者的两倍多。用脉冲多普勒超声评价IF流量(Q(IF))的值。在牛体外研究中，使用新开发的探头滑块，沿着透析器直接测量了透析器横截面的血流速度。多普勒超声是一种有用的床边监测透析器中Q(IF)值的方法，因为它对患者是非侵入性的。在牛的体外实验中，测定了6h的Q(IF)值的时间进程。Q(IF)在实验开始后45min内下降，之后趋于恒定值。虽然肌酐和β(2)-微球蛋白K值在实验过程中保持不变，但α1-微球蛋白K值和白蛋白K值随着时间的推移而急剧下降。这是因为这些溶质通过膜的传输受到污染的强烈影响。在实验研究中阐明了IFEHD的有效性。然而，开发具有增强型IF的透析器应考虑到患者的安全性。应避免透析液对患者的内毒素侵入等污染。版权所有(C)2009 S.Karger AG，巴塞尔
In order to improve solute removal efficiency, several types of dialyzers with enhanced internal filtration (IF) were introduced for clinical applications. In these dialyzers, enhanced IF increased convective transport of the solute in addition to diffusive transport. Internal filtration-enhanced hemodialysis (IFEHD) defined as hemodialysis therapy using the enhanced IF dialyzer seems to be more convenient in comparison with conventional hemodiafiltration therapies because of no additional equipments such as a roller pump. In this paper, the validity of IFEHD was examined during several types of experimental studies. As a result, the experimental study with several types of enhanced IF dialyzers indicated values of relative solute clearance in an aqueous solution that were higher than unity compared to the conventional dialyzer. The K values obtained for myoglobin as a larger molecule were more than twice as high. The value of IF flow rate (Q(IF)) was evaluated by pulsed Doppler ultrasonography. The blood flow velocity at a cross-sectional plane of the dialyzer was directly measured along the dialyzer during a bovine in vitro study using a newly developed probe slider. Doppler ultrasonography is a useful method as a bedside monitoring of the Q(IF) value in a dialyzer because it is noninvasive for the patient. Time course of the Q(IF) value was examined for 6 h during a bovine in vitro study. The Q(IF) decreased within 45 min after the start of the experiment and reached constant values after that. Although creatinine and beta(2)-microglobulin K values remained constant with time during the experiment, alpha 1-microglobulin K values gradually and albumin K value steeply decreased with time. This is because these solutes transfer through the membrane strongly affected by fouling. The validity of IFEHD was clarified during the experimental studies. Development of a dialyzer with enhanced IF, however, should take account of the patient's safety. Contaminations such as endotoxin invasion from the dialysate to the patient should be avoided. Copyright (C) 2009 S. Karger AG, Basel