Increasing dialysate flow and dialyzer mass transfer area coefficient to increase the clearance of protein-bound solutes
Increasing dialysate flow and dialyzer mass transfer area coefficient to increase the clearance of protein-bound solutes
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DOI：
10.1097/01.asn.0000131521.62256.f0
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发表时间：
2004-07-01
影响因子：
13.6
通讯作者：
Hostetter, TH
中科院分区：
文献类型：
--
作者：
Meyer, TW;Leeper, EC;Hostetter, TH
临床血液透析系统实现了不与血浆蛋白结合的小溶质的高单程提取。但它们清除蛋白质结合溶质的效率要低得多。本研究检查了通过增加透析器传质面积系数（K（o）A）和透析液流速（Q（d））提高蛋白结合供试溶质清除率的程度。使用标准临床透析液输送系统对含有供试溶质和人工血浆（白蛋白浓度约为4 g/dl）的储液器进行透析。在血浆流速（Q（p））为200 ml/min，K（o）A和Q（d）值不同的情况下，将酚红（Cl-PR）的清除率与尿素和肌酐的清除率进行了比较。当酚红的K（o）A（PR）从238 ml/min增加到640 ml/min，Q从286 +/- 6 ml/min增加到734 +/- 9 ml/min时，Cl-PR从11 +/- 2 ml/min增加到23 +/- 2 ml/min。单独增加K（o）A（PR）或Q（d）的影响较小。酚红的清除值远低于未结合溶质尿素和肌酐的清除值，其范围为150至200 ml/min，受不同K（o）A和Q（d）的影响较小。建立了一个数学模型，根据Q（p）、Q（d）、与白蛋白结合的酚红分数（94% +/- 1%）和K（o）A（PR）值预测Cl-PR。该模型准确地预测了测量结果的模式，并进一步表明，只有通过K（o）A（PR）和Q（d）的非常大的增加，才能使Cl-PR接近Q（p）。
Clinical hemodialysis systems achieve high single pass extraction of small solutes that are not bound to plasma proteins. But they clear protein-bound solutes much less effectively. This study examines the extent to which clearance of a protein-bound test solute is improved by increasing the dialyzer mass transfer area coefficient (K(o)A) and the dialysate flow rate (Q(d)). A reservoir containing test solutes and artificial plasma with albumin concentration approximately 4 g/dl was dialyzed with a standard clinical dialysate delivery system. The clearance of phenol red (Cl-PR) was compared with the clearances of urea and creatinine at a plasma flow rate (Q(p)) of 200 ml/min with varying values of K(o)A and Q(d). Cl-PR increased from 11 +/- 2 ml/min to 23 +/- 2 ml/min when K(o)A for phenol red, K(o)A(PR), was increased from 238 to 640 ml/min and Q, was increased from 286 +/- 6 ml/min to 734 +/- 9 ml/min. Increasing either K(o)A(PR) or Q(d) alone had lesser effects. Clearance values for phenol red were much lower than clearance values for the unbound solutes urea and creatinine, which ranged from 150 to 200 ml/min and were less affected by varying K(o)A and Q(d). A mathematical model was developed to predict Cl-PR from values of Q(p), Q(d), the fraction of phenol red bound to albumin (94% +/- 1%) and K(o)A(PR). The model accurately predicts the pattern of measured results and shows further that Cl-PR can be made to approach Q(p) only by very large increases in both K(o)A(PR) and Q(d).