高通量透析器的临床应用

A comparative study of the performance of high-flux versus low-flux hemodialysis

目的 :观察高通量透析器BLS 814G用于常规血液透析时对几种尿毒症毒素的清除能力。 方法 :选择 30例常规血液透析患者 ,随机分为A、B两组。A组患者 (n =15 )继续使用其原来的低通量透析器ME15H(Kawasumi,膜面积 1 5m2 ,超滤系数 7 7ml/mmHg.h) ;B组患者改用高通量透析器DIAPESBLS 814G (Bellcos.p .a ,膜面积 1 4m2 ,超滤系数 6 1ml/mmHg .h)。所有患者均采用动静脉内瘘及碳酸氢盐透析 ,透析液流量 5 0 0ml/min ,血流量 2 5 0ml/min ,透析时间 4 5h。透析器第一次使用时监测尿素氮 (BUN)、肌酐 (SCr)、尿酸 (UA)、磷及 β2 微球蛋白(β2 M)的清除率 ,以及透析前、后BUN、KT/V及磷、β2 M的下降率。 结果 :A组患者BUN、SCr、尿酸清除率及KT/V分别为 (190 1± 2 7 6 )ml/min、(172 5± 16 9)ml/min、(173 1± 2 1 4 )ml/min和 1 5 4± 0 34;B组患者BUN、SCr、UA清除率及KT/V分别为 (2 10 2± 14 5 )ml/min、(176 4± 2 4 2 )ml/min、(174 8± 2 2 8)ml/min和 1 70± 0 4 0 ,两组之间无显著差异 (P >0 0 5 )。A、B两组对磷的清除率分别为 (15 6 1± 14 3)ml/min、(178 7± 2 3 4 )ml/min ,透析前、后磷的下降率分别为 (5 0 4± 13 3) %、(6 2 7± 11 4 ) % ,两组之间差异显著 (P

Objective:To determine and compare the removal of uremic toxins in regular hemodialysis patients using high flux dialyzers and patients using low flux dialyzers. Methodology:Thirty maintenance hemodialysed patients were involved in this study.They were randomly divided into Group A and Group B.Patients in Group A ( n =15) were hemodialysed as previously with dialyzers ME15H(Kawasumi,UFR 7 7 ml/mmHg.h),and patients in Group B( n =15) switched to a high flux dialyzer DIAPES BLS 814G(Bellco s.p.a.,UFR 61 ml/mmHg.h).All the patients were hemodialysed with bicarbonate dialysate at rate of 500 ml/min,blood flow at rate of 250 ml/min,and dialysis duration of 4 5 h.Clearance of urea nitrogen,creatinine,uric acid,phosphate and β 2-microglobulin(β 2 M),and KT/Vurea,reduction rate of phosphate and β 2 M post dialysis were monitored when a dialyzer was used for the first time. Results:Clearance of urea nitrogen,creatinine,uric acid and KT/V in Group A and in Group B were (190.1±27 6) ml/min vs (210 2±14 5) ml/min,(172 5±16 9) ml/min vs (176 4±24 2) ml/min,(173 1±21 4) ml/min vs (174 8±22 8) ml/min,and 1 54±0 34 vs 1 70±0 40.No significant difference was found in the above parameters between two groups( P >0 05).Clearance (178 7±23 4) ml/min and reduction rate (62 7±11 4)% of phosphate in Group B were significantly greater than in Group A [clearance(156 1±14 3) ml/min,reduction rate(50 5±13 3)%]( P <0 05).Clearance and reduction rate of β 2 M in Group A were neglectable,but those in Group B [clearance(60 5±19 9)ml/min,reduction rate(56 4±7 7)%] were 10 folds greater than that in Group A ( P <0 001). Conclusion:The removal of phosphate and β 2 M by high flux dialyzer BLS814G was much greater than those low flux dialyzer ME15H,especially the removal of β 2 M,despite of the insignificant difference in removal of urea nitrogen,creatinine and uric acid between the two dialyzers.