Protein-Bound Uremic Toxin Profiling as a Tool to Optimize Hemodialysis.
Protein-Bound Uremic Toxin Profiling as a Tool to Optimize Hemodialysis.
复制标题
DOI：
10.1371/journal.pone.0147159
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Vanholder R
中科院分区：
文献类型：
--
作者：
Eloot S;Schneditz D;Cornelis T;Van Biesen W;Glorieux G;Dhondt A;Kooman J;Vanholder R
我们研究了用于清除与心血管损伤相关的蛋白结合溶质的各种血液透析策略。本研究纳入了10例接受标准（3x 4小时/周）高通量血液透析的患者。在周中的几个时间点，在透析器入口和出口处采集血液。测定了几种蛋白结合溶质的总浓度和游离浓度以及尿素浓度。根据溶质，将两室动力学模型拟合至测量浓度，估计血浆体积（V1）、总分布体积（Vtot）和室间清除率（K21）。然后使用该校准模型计算哪种血液透析策略提供最佳清除。我们自己的体内数据，与策略变量输入到数学模拟，然后验证对独立的数据，从其他两个临床研究。透析器清除率K、V1和Vtot与蛋白结合百分比呈负相关。所有K都是彼此不同的。在所有蛋白结合溶质中，K21比尿素低2.7-5.3倍。在300 mL/min血流量下，每周处理与标准3x 4 h透析相同血量的更长时间和/或更频繁的透析在清除强结合溶质方面无差异。然而，与标准透析相比，每周处理更多血液的更长和/或更频繁的透析策略明显更充分。这些结论得到了成功验证。当每单位时间的血液和透析液流量以及血液透析器类型保持不变时，通过增加频率和/或疗程持续时间来增加每周处理的血液量明显增加清除。
We studied various hemodialysis strategies for the removal of protein-bound solutes, which are associated with cardiovascular damage. This study included 10 patients on standard (3x4h/week) high-flux hemodialysis. Blood was collected at the dialyzer inlet and outlet at several time points during a midweek session. Total and free concentration of several protein-bound solutes was determined as well as urea concentration. Per solute, a two-compartment kinetic model was fitted to the measured concentrations, estimating plasmatic volume (V1), total distribution volume (Vtot) and intercompartment clearance (K21). This calibrated model was then used to calculate which hemodialysis strategy offers optimal removal. Our own in vivo data, with the strategy variables entered into the mathematical simulations, was then validated against independent data from two other clinical studies. Dialyzer clearance K, V1 and Vtot correlated inversely with percentage of protein binding. All Ks were different from each other. Of all protein-bound solutes, K21was 2.7–5.3 times lower than that of urea. Longer and/or more frequent dialysis that processed the same amount of blood per week as standard 3x4h dialysis at 300mL/min blood flow showed no difference in removal of strongly bound solutes. However, longer and/or more frequent dialysis strategies that processed more blood per week than standard dialysis were markedly more adequate. These conclusions were successfully validated. When blood and dialysate flow per unit of time and type of hemodialyzer are kept the same, increasing the amount of processed blood per week by increasing frequency and/or duration of the sessions distinctly increases removal.