Asymmetric dimethylarginine compartmental behavior during high-flux hemodialysis
Asymmetric dimethylarginine compartmental behavior during high-flux hemodialysis
复制标题
高通量血液透析过程中不对称二甲基精氨酸区室行为
DOI：
10.1080/0886022x.2020.1797790
复制
发表时间：
2020-01-01
期刊：
影响因子：
3
通讯作者：
Yan, Yucheng
中科院分区：
文献类型：
--
作者：
Du, Qiuna;Gao, Jiayuan;Yan, Yucheng
摘要目的不对称二甲基精氨酸（ADMA）等尿毒症毒素的积累已成为终末期肾病（ESRD）患者心血管疾病相关的主要危险因素之一。基于ADMA的低分子量，血液透析（HD）理论上应该能有效去除ADMA。在这项研究中，我们研究了ADMA在高通量HD中的清除行为。方法选取8例无肾功能残留的HD患者。分别于透析开始后0、30、60、120、240 min以及透析后1 h、48 h采血。HPLC-MS/MS检测ADMA水平。在这里，我们测量了ADMA在血细胞中的水平和ADMA蛋白的结合率。据此，确定了透析器的提取比例。结果ADMA（经血液浓度校正）的降低率（RR）仅为37.21±6.44%，显著低于尿素和肌酐（p < 0.05）。有趣的是，它在透析早期从血浆中清除是陡峭的，从60到240分钟变得缓慢。此外，ADMA的进口红细胞浓度高于血浆浓度。ADMA与肌酐或尿素的透析器提取率具有可比性（ADMA为83±5%，肌酐和尿素分别为84±3%和88±2%，p均为0.05）。尿素和肌酐在HD完成后1 h的回弹率小于10%。相比之下，在ADMA中检测到大约30%的反弹。结论本研究提示ADMA可能呈多室分布，尿素动力学模型不能代表性地反映。
Abstract Aim The accumulation of uremic toxins, such as asymmetric dimethylarginine (ADMA), has emerged as one of the major cardiovascular disease-related risk factors in patients with end-stage renal disease (ESRD). Based on the low molecular weight of ADMA, hemodialysis (HD) should theoretically effectively remove ADMA. In this study, we investigated the clearance behavior of ADMA during high-flux HD. Methods Eight HD patients without residual renal function were included. Blood samples were collected at 0, 30, 60, 120 and 240 min after dialysis started, as well as 1 h and 48 h after dialysis. ADMA level was detected by HPLC-MS/MS. Herein, the ADMA level in blood cells and the ADMA protein binding rate were measured. Accordingly, the dialyzer extraction ratio was also determined. Results The reduction ratio (RR) of ADMA (corrected for hemoconcentration) was significantly lower, at only 37.21 ± 6.44%, than that of urea and creatinine (p < .05). Interestingly, its clearance from plasma was precipitous early in dialysis and became slowly from 60 to 240 min. Additionally, a greater inlet erythrocyte than plasma concentration was found for ADMA. The dialyzer extraction ratio was comparable between ADMA and creatinine or urea (83 ± 5% for ADMA vs. 84 ± 3% and 88 ± 2% for creatinine and urea, respectively; both p>.05). Urea and creatinine had a slight rebound ratio of less than 10% at 1 h after the completion of HD. In contrast, considerable rebound of approximately 30% was detected in ADMA. Conclusion This study suggests that ADMA may present a multicompartmental distribution that cannot be representatively reflected by the urea kinetics model.