Are all dialyzers compatible with the convective volumes suggested for postdilution online hemodiafiltration?
Are all dialyzers compatible with the convective volumes suggested for postdilution online hemodiafiltration?
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DOI：
10.5301/ijao.5000525
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发表时间：
2016-09-01
影响因子：
1.7
通讯作者：
Bouet, Julien
中科院分区：
文献类型：
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作者：
Potier, Jacky;Queffeulou, Guillaume;Bouet, Julien
最近对4项随机对照试验的分析证实，与血液透析相比，稀释后在线血液滤过（OL-HDF）的死亡风险更低，尤其是对于输送体表面积标准化对流体积（CV/BSA > 23 L/1.73 m(2)/次）最高的患者。由于这些试验中使用的透析器的影响从未被研究过，我们回顾性分析了19种常用透析器进行的临床试验。目的是提供有关他们的表现和行为的信息，以帮助客观选择与OL-HDF相关的治疗方法。方法：在CV/BSA为0 ~ 30 L时，通过测定β -2微球蛋白（RR β 2M）和肌红蛋白（RRmyo）的还原率来评估“效率”，并在CV/BSA = 23 L时进行外推。“安全”是由安全CV （CVsafe）定义的，对应于CV/BSA，高于该CV/BSA的白蛋白损失为0.5 g/次。结果：在CV/BSA = 23 L时，所有透析器均能保证最佳的β 2M提取率（RR: 76% ~ 84.5%）。对于肌红蛋白，效率差异更大（RRmyo: 40%-85%）。最重要的是，4/19透析器损失超过5克白蛋白，不应在这些条件下使用。结论：建议处方安全的透析器。此外，如果考虑到中间分子溶质的去除高于其跨膜运输所需的CV，那么当条件不允许达到建议的CV/BSA目标时，可能会规定一些在CV/BSA = 23 L时更有效的透析剂。
Introduction: The recent analysis of 4 randomized controlled trials has confirmed the lower mortality risk for postdilution online hemodiafiltration (OL-HDF) compared to hemodialysis, and above all for patients with the highest delivered body surface area standardized convective volume (CV/BSA > 23 L/1.73 m(2)/session). Since the impact of the dialyzers used in these trials has never been studied, we retrospectively analyzed clinical tests carried out with 19 commonly used dialyzers. The aim was to provide information on their performances and behavior to aid in an objective choice for therapies associated with OL-HDF.Methods: "Efficiency" was evaluated by measuring the reduction ratio of beta-2 microglobulin (RR beta 2M) and myoglobin (RRmyo) for a CV/BSA between 0 and 30 L, extrapolating them at CV/BSA = 23 L. "Safety" was defined by the safe CV (CVsafe), corresponding to the CV/BSA above which albumin loss is >5 g/session.Results: With CV/BSA = 23 L, all the dialyzers ensure an optimal beta 2M extraction (RR beta 2M: 76%-84.5%). For myoglobin, efficiency disparities are bigger (RRmyo: 40%-85%). Above all, 4/19 dialyzers lose more than 5 g albumin and should not be used under these conditions.Conclusions: It is recommended to prescribe dialyzers that are above all safe. Moreover, if one considers that the removal of middle molecule solutes prevails over the CV necessary for their transmembrane transport, some dialyzers that are more efficient with CV/BSA = 23 L might then be prescribed when the conditions do not permit the suggested CV/BSA goal to be achieved.