Dialyzer Reuse and Outcomes of High Flux Dialysis.
Dialyzer Reuse and Outcomes of High Flux Dialysis.
复制标题
DOI：
10.1371/journal.pone.0129575
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Unruh ML
中科院分区：
文献类型：
--
作者：
Argyropoulos C;Roumelioti ME;Sattar A;Kellum JA;Weissfeld L;Unruh ML
高通量(HF)血液透析在全球推广使用的大部分随机试验证据来自两个随机对照试验，其中一个(血液透析，HEMO)允许，而另一个(膜结果通透性，MPO)排除，膜的重复使用。目前尚不清楚透析器重复使用对HF透析器和低飞度(LF)透析器的预后是否有不同影响。使用比例风险模型和纵向测量与生存结果的联合模型来分析β-2-微球蛋白(β-2M)浓度、流量和重复使用之间的关系。采用Meta分析和回归分析技术，从血液和MPO中综合进行HF透析的证据。在hemo中，最小限度地重复使用(<；与最少使用高频透析器相比，HF透析器的危险比(HR)分别为0.67(95%可信区间，95%CI：0.48~0.92，p=0.015)、0.64(95%CI：0.44~0.95，p=0.03)、0.61(95%CI：0.41~0.90，p=0.012)、0.53(95%CI：0.28~1.02，p=0.057)。对于所有原因和心血管原因导致的死亡，这些关系对于广泛重复使用的膜(重复使用和通量之间的交互作用p=0.001，p=0.005)是相反的，而心脏和感染死亡率也注意到类似的趋势(重复使用和通量之间的交互作用p分别为0.10%和0.08%)。β2M的减少只解释了最少重复使用的HF透析器对所有原因死亡率的影响的三分之一，而非β2M相关因素解释了更广泛重复使用的透析器的益处明显减弱。血液和MPO的Meta回归估计，与未重复使用的LF膜相比，未重复使用的HF透析器的调整HR为0.63(95%CI：0.51-0.78)。这两个大型血液透析试验的二次分析和综合支持了过去十年来HF透析器在临床血液透析中的广泛使用。从机理上了解HF透析的效果和透析器的再利用过程可能会为尿毒症毒性提供新的生物标志物，并可能加速膜技术创新，从而改善患者的预后。
The bulk of randomized trial evidence for the expanding use of High Flux (HF) hemodialysis worldwide comes from two randomized controlled trials, one of which (HEMODIALYSIS, HEMO) allowed, while the other (Membrane Outcomes Permeability, MPO) excluded, the reuse of membranes. It is not known whether dialyzer reuse has a differential impact on outcomes with HF vs low flyx (LF) dialyzers. Proportional Hazards Models and Joint Models for longitudinal measures and survival outcomes were used in HEMO to analyze the relationship between β2-microglobulin (β2M) concentration, flux, and reuse. Meta-analysis and regression techniques were used to synthesize the evidence for HF dialysis from HEMO and MPO. In HEMO, minimally reused (< 6 times) HF dialyzers were associated with a hazard ratio (HR) of 0.67 (95% confidence interval, 95%CI: 0.48–0.92, p = 0.015), 0.64 (95%CI: 0.44 – 0.95, p = 0.03), 0.61 (95%CI: 0.41 – 0.90, p = 0.012), 0.53 (95%CI: 0.28 – 1.02, p = 0.057) relative to minimally reused LF ones for all cause, cardiovascular, cardiac and infectious mortality respectively. These relationships reversed for extensively reused membranes (p for interaction between reuse and flux < 0.001, p = 0.005) for death from all cause and cardiovascular causes, while similar trends were noted for cardiac and infectious mortality (p of interaction between reuse and flux of 0.10 and 0.08 respectively). Reduction of β2M explained only 1/3 of the effect of minimally reused HF dialyzers on all cause mortality, while non-β2M related factors explained the apparent attenuation of the benefit with more extensively reused dialyzers. Meta-regression of HEMO and MPO estimated an adjusted HR of 0.63 (95% CI: 0.51–0.78) for non-reused HF dialyzers compared with non-reused LF membranes. This secondary analysis and synthesis of two large hemodialysis trials supports the widespread use of HF dialyzers in clinical hemodialysis over the last decade. A mechanistic understanding of the effects of HF dialysis and the reuse process on dialyzers may suggest novel biomarkers for uremic toxicity and may accelerate membrane technology innovations that will improve patient outcomes.