Removal of Protein-Bound Solutes by Dialysis

描述(由申请人提供)： 传统的血液透析很难清除与血浆蛋白结合的溶质。这种溶质的积聚可能导致透析患者尿毒症的残留。拟议的研究将测量蛋白结合溶质清除，并测试降低透析患者蛋白结合溶质水平的方法。 第一个目标是降低常规血液透析患者的蛋白质结合溶质水平。拟议的研究将测试是否可以通过增加透析器的传质面积系数和透析液流量，在不增加透析时间的情况下降低蛋白质结合溶质的水平。 第二个目的是确定不同的透析处方如何影响每日夜间血液透析(DNHD)患者的蛋白结合溶质水平。拟议的研究将检验以下预测，即DNHD过程中蛋白质结合溶质的清除量可以独立于尿素清除量而变化，并且可以通过增加透析液流量来增加。 第三个目的是测量参加频繁血液透析网络(FHN)试验的受试者的蛋白质结合溶质水平。拟议的FHN辅助研究将提供一个独特的机会，在一大群血液透析患者中将蛋白质结合溶质水平与其他化学参数和健康指数联系起来。

DESCRIPTION (provided by applicant): Solutes that bind to plasma proteins are poorly cleared by conventional hemodialysis. Accumulation of such solutes may contribute to residual uremic illness in dialysis patients. The proposed studies will measure protein-bound solute clearances and test means for reducing protein-bound solute levels in dialysis patients. The first aim is to reduce protein-bound solute levels in patients on conventional hemodialysis. The proposed studies will test whether levels of protein-bound solutes can be reduced without any increase in dialysis time by raising the dialyzer mass transfer area coefficient and dialysate flow. The second aim is to determine how different dialysis prescriptions effect protein-bound solute levels in patients on daily nocturnal hemodialysis (DNHD). The proposed studies will test the prediction that the clearance of protein-bound solutes during DNHD can be varied independent of urea clearance, and that it can be increased by increasing dialysate flow. The third aim is to measure protein-bound solute levels in subjects enrolled in the Frequent Hemodialysis Network (FHN) trial. The proposed ancillary study to the FHN will provide a unique opportunity to relate protein-bound solute levels to other chemical parameters and indices of well-being in a large group of hemodialysis patients.