High-quality dialysis: a lesson from the Japanese experience
High-quality dialysis: a lesson from the Japanese experience
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DOI：
10.1093/ndtplus/sfq034
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发表时间：
2010-05-01
影响因子：
4.6
通讯作者：
Masakane, Ikuto
中科院分区：
文献类型：
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作者：
Masakane, Ikuto
高质量的透析并不总是意味着高效率;透析应保持营养平衡和完全的生物相容性。在使用聚甲基丙烯酸甲酯（PMMA）和/或乙烯乙烯醇共聚物（EVAL）膜透析器进行治疗时，对于接受前稀释在线血液透析滤过（HDF）的患者，聚砜膜引起的体重减轻也得到了显著改善。这些膜被认为在一定程度上抑制小分子量物质的清除，以保持广泛去除低分子量蛋白质的精确平衡。这个清除过程被认为是非常接近于由肾脏的清除特性所维持的平衡。另一方面，液体净化也是高质量透析的重要因素之一。透析液细菌污染是影响透析治疗生物相容性的重要因素之一。从这一治疗理念来看，我们设施中的患者生存率非常高：1年生存率为91.1%，5年生存率为76.6%，尽管我们患者的平均年龄为69岁。我们通常根据患者的主诉调整治疗方式，我们称之为“患者导向透析”（POD）。在POD系统中，尿毒症瘙痒或睡眠障碍的患病率低于DOPPS。采用PMMA、EVAL或前稀释在线HDF的蛋白质泄漏透析模式是POD系统的关键概念。
High-quality dialysis does not always mean high efficiency; dialysis should maintain nutritional balance and full biocompatibility. In undergoing treatment with polymethylmethacrylate (PMMA) and/or ethylene vinyl alcohol copolymer (EVAL) membrane dialysers, the body weight decrease caused by polysulfone membrane has been dramatically improved for those receiving predilution online haemodiafiltration (HDF) as well. These membranes are assumed to somewhat suppress the clearance of small molecular weight substances to maintain an exquisite balance of broadly removing low molecular weight proteins. This removal process is assumed to be extremely close to the balance maintained by the clearing characteristics of the kidneys. On the other hand, fluid purification is also one of the important factors in high-quality dialysis. Bacteriological contamination of dialysis fluid is one of the serious factors that deteriorate the biocompatibility of dialysis therapy. From this therapeutic concept, the patient survival rate is excellent in our facilities: the 1-year survival rate is 91.1% and the 5-year survival rate is 76.6%, although the mean age of our patients is 69 years. We usually adjust the therapeutic modality based on patient complaints, and we call thisconcept' patient-orienteddialysis'(POD). InthePODsystem, the prevalence of uraemic pruritus or sleep disturbances waslowerthanthatoftheDOPPS. Theprotein-leakingdialysis modalities with PMMA, EVAL or predilution online HDF formthe key concept in thePODsystem.