Effect of increasing dialyzer mass transfer area coefficient and dialysate flow on clearance of protein-bound solutes: a pilot crossover trial.
Effect of increasing dialyzer mass transfer area coefficient and dialysate flow on clearance of protein-bound solutes: a pilot crossover trial.
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DOI：
10.1053/j.ajkd.2009.01.265
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发表时间：
2009-06
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影响因子：
--
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中科院分区：
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蛋白质结合的溶质通过常规血液透析很难清除，因为蛋白质结合限制了驱动扩散的“游离”溶质浓度。本研究测试了模型预测，即通过将透析器传质面积系数（KoA）和透析液流量（Qd）提高到传统实践中使用的水平以上，可以增加结合溶质的清除率。试点交叉试验6名稳定的长期血液透析患者研究参与者接受了实验性透析治疗，其中通过使用两台透析器串联并使用两台透析机为每台透析器提供800 ml/min的Qd，与使用单台透析器和由一台透析机提供800 ml/min的Qd的常规治疗期间相比，KoA和Qd增加。测定尿毒症溶质的清除率测定尿素氮（UN）和结合溶质对甲酚硫酸盐（PCS）、硫酸吲哚酚（IS）、犬尿烯酸（KYNA）和马尿酸盐的清除率。常规治疗期间结合溶质的清除率低于UN（清除率值：UN 255±16 ml/min; PCS 23±4 ml/min; IS 30±7 ml/min; KYNA 43±4 ml/min;马尿酸盐115±11 ml/min）。实验处理增加了所有溶质的清除率（清除率值：UN 318±19 ml/min; PCS 37±6 ml/min; IS 46±8 ml/min; KYNA 73±7 ml/min;马尿酸盐165±17 ml/min）。结合溶质的清除率增加幅度大于UN（清除率增加：UN 25± 6%; PCS 66± 19%; IS 57± 27%; KYNA 69± 5%;马尿酸盐44± 15%）。需要进行更长期的研究，以确定结合溶质的透析清除率增加是否会导致血浆溶质水平降低。通过将KoA和Qd提高到常规水平以上，可以增加蛋白结合溶质的透析清除率。
Protein bound solutes are poorly cleared by conventional hemodialysis because protein binding limits the ‘free’ solute concentration driving diffusion. This study tested the modeled prediction that clearances of bound solutes could be increased by raising the dialyzer mass transfer area coefficient (KoA) and dialysate flow (Qd) above the levels used in conventional practice. Pilot, cross-over trial. Six stable long-term hemodialysis patients Study participants underwent an experimental dialysis treatment in which KoA and Qd were increased by using two dialyzers in series and supplying each dialyzer with a Qd of 800 ml/min by using two dialysis machines compared to those during a conventional treatment with a single dialyzer and Qd of 800 ml/min supplied by one machine. Measured clearances of uremic solutes Clearances were measured for urea nitrogen (UN) and the bound solutes p-cresol-sulfate (PCS), indoxyl sulfate (IS), kynurenic acid (KYNA) and hippurate. Clearances for the bound solutes during conventional treatment were lower than for UN (clearance values: UN 255±16 ml/min; PCS 23±4 ml/min; IS 30±7 ml/min; KYNA 43±4 ml/min; hippurate 115±11 ml/min). Experimental treatment increased the clearances of all the solutes (clearance values: UN 318±19 ml/min; PCS 37±6 ml/min; IS 46±8 ml/min; KYNA 73±7 ml/min; hippurate 165±17 ml/min). The magnitude of the increases in clearance was greater for the bound solutes than for UN (increase in clearance: UN 25±6 %; PCS 66±19 %; IS 57±27 %; KYNA 69±5 %; hippurate 44±15 %). A longer term study would be required to determine if increased dialytic clearance of bound solutes leads to reduction in plasma solute levels. The dialytic clearance of protein-bound solutes can be increased by raising KoA and Qd above conventional levels.
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影响因子：
2.4
作者：
Meijers, Bjoern K.;Weber, Viktoria;Evenepoel, Pieter
通讯作者：
Evenepoel, Pieter
影响因子：
19.6
作者：
Vanholder, R;De Smet, R;Lameire, N
通讯作者：
Lameire, N
影响因子：
13.2
作者：
Bammens, B;Evenepoel, P;Vanrenterghem, Y
通讯作者：
Vanrenterghem, Y
DOI：
10.1097/01.asn.0000131521.62256.f0
发表时间：
2004-07-01
影响因子：
13.6
作者：
Meyer, TW;Leeper, EC;Hostetter, TH
通讯作者：
Hostetter, TH
影响因子：
10.4
作者：
Dou, L.;Jourde-Chiche, N.;Brunet, P.
通讯作者：
Brunet, P.