Removal of the protein-bound solute p-cresol by convective transport: A randomized crossover study
Removal of the protein-bound solute p-cresol by convective transport: A randomized crossover study
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DOI：
10.1053/j.ajkd.2004.04.033
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发表时间：
2004-08-01
影响因子：
13.2
通讯作者：
Vanrenterghem, Y
中科院分区：
文献类型：
--
作者：
Bammens, B;Evenepoel, P;Vanrenterghem, Y
背景：常规血液透析（HD）对中分子（LDL）和蛋白结合溶质的清除效果较差。血液透析滤过（HDF）在单次治疗中结合了对流和扩散，已被证明在消除几种小型和大型滞留分子方面具有上级优势。在对流策略中，有关蛋白结合溶质消除的信息很少。本随机交叉研究的主要目的是评价内部过滤、后稀释HDF和前稀释HDF对蛋白结合溶质对甲酚清除的影响。研究方法：14例接受每周3次常规中通量HD治疗的稳定患者被分配到5个治疗阶段，每个治疗阶段2周：HF 80（S）HD; FX 80 HD;后稀释HDF，20 L，FX 80;前稀释HDF，20 L，FX 80;和前稀释HDF，60 L，FX 80（所有透析器均来自Fresenius Medical Care，Bad洪堡，德国）。结果对于水溶性溶质，在HDF期间对甲酚的消除更好，并且随着过滤体积的增加而增加。HDF期间β 2-微球蛋白（β 2 m）的清除也得到增强。然而，当应用高前稀释置换体积时，对流的积极作用被抵消，可能是稀释的结果。在每种透析方法中，MM β 2 m和蛋白结合溶质对甲酚的清除率明显低于水溶性分子尿素氮和肌酐。结论：我们的数据表明，与高通量HD相比，对流可提供上级蛋白结合溶质清除。我们的研究结果还表明，更好地消除未结合部分是最合理的潜在机制。
Background: Middle molecules (MMs) and protein-bound solutes are poorly removed by conventional hemodialysis (HD). Hemodiafiltration (HDF) combines convection and diffusion in a single therapy and has been shown to be superior for the elimination of several small and larger retention molecules. Information on the elimination of protein-bound solutes during convective strategies is scarce. The primary aim of this randomized crossover study is to evaluate the influence of internal filtration, postdilution HDF, and predilution HDF on removal of the protein-bound solute p-cresol. Methods: Fourteen stable patients on regular thrice-weekly medium-flux HD therapy were assigned to 5 treatment periods of 2 weeks each for: HD with HF80(S); HD with FX80; postdilution HDF, 20 L, with FX80; predilution HDF, 20 L, with FX80; and predilution HDF, 60 L, with FX80 (all dialyzers from Fresenius Medical Care, Bad Homburg, Germany). Results As for the water-soluble solutes, elimination of p-cresol was better during HDF and increased with greater filtration volumes. Removal of beta(2)-microglobulin (beta(2)m) also was enhanced during HDF. However, the positive effect of convection was off set when high predilution substitution volumes were applied, probably as a result of dilution. Within each dialytic approach, removal of the MM beta(2)m and the protein-bound solute p-cresol was significantly less than that of the water-soluble molecules urea nitrogen and creatinine. Conclusion: Our data indicate that convection can provide superior protein-bound solute removal compared with high-flux HD. Our findings also suggest that better elimination of the unbound fraction is the most plausible underlying mechanism.