背景:尽管透析领域取得了重大进展,仍然有一些未满足的需求,例如通过适当的净化来减少炎症。众所周知,目前的透析技术不能有效地除去广谱的促炎和促动脉粥样硬化尿毒症毒素。吸附似乎是去除毒素的额外工具,但其效果和优化尚未得到广泛研究。本报告的目的是提供有关使用高吸附性聚甲基丙烯酸甲酯膜进行血液透析滤过的可能性的初步结果。
方法:该研究首先在10例患者中进行,其中通过测量溶血指标来测试PMMABG-U2.1膜血液透析滤过的安全性和可行性,跨膜压力,和透析充分性。对20例患者进行了为期18个月的前瞻性观察,在此期间他们连续接受了标准血液透析,标准稀释后血液透析滤过,和基于聚甲基丙烯酸甲酯的稀释后血液透析滤过。在整个观察期间测量蛋白质结合的尿毒症毒素浓度和炎症标志物。
结果:HDFPMMA在对流体积上不如HDF,但KT/V相似,两种治疗期间的手术压力无差异.在HDFPMMA治疗期间,我们观察到CPR水平显着降低,和HDFPMMA在Hepcidin去除方面优于所有其他治疗,即使这没有显着影响血红蛋白水平。HDFPMMA可以在六个月内显着降低硫酸吲哚酚(Indoxyl)的浓度,但对对甲苯基硫酸酯(P-cresyl)却没有。结论:PMMABG-U2.1膜可以安全有效地用于血液透析滤过。此外,如这些初步结果所示,在对流和扩散中添加吸附特性使得与CRP和Hepcidin等炎症标志物减少相关的吲哚酚尿毒症毒素的去除增加,而对白蛋白水平没有任何负面影响。
BACKGROUND: Despite major advances in the field of dialysis, there are still some unmet needs such as reducing inflammation through adequate depuration. It is well known that the wide spectrum of pro-inflammatory and pro-atherosclerotic uremic toxins are inefficiently removed by current dialysis techniques. Adsorption seems to be an extra tool to remove toxins, but its effect and optimization have not been widely studied. The aim of this report was to present preliminary results regarding the possibility of performing
hemodiafiltration with a highly adsorptive polymethylmethacrylate membrane.
METHODS: The study was first conducted in 10 patients in which the safety and feasibility of
hemodiafiltration with PMMA BG-U 2.1 membrane were tested through measurement of hemolysis indices, transmembrane pressures, and dialysis adequacy. Twenty patients were prospectively observed for 18-month period in which they consecutively underwent standard hemodialysis, standard post-dilution
hemodiafiltration, and polymethylmethacrylate-based post-dilution
hemodiafiltration. Protein-bound uremic toxins concentrations and inflammatory markers were measured throughout the observed period.
RESULTS: HDF-PMMA was inferior to HDF in convective volume, but KT/V was similar, and no differences were noted in operating pressures during the two treatments. During HDF-PMMA period of treatment, we observed a significant reduction of CPR levels, and HDF-PMMA was superior to all other treatments in hepcidin removal even if this did not significantly affect hemoglobin levels. HDF-PMMA could significantly reduce indoxyl sulfate (indoxyl) concentration over a period of 6 months but not for p-cresyl sulfate (p-cresyl).
CONCLUSIONS: PMMA BG-U 2.1 membrane can be safely and efficiently used in
hemodiafiltration. Moreover, as these preliminary results show, adding adsorption properties to convection and diffusion enabled an increased removal of indoxyl uremic toxin associated to a reduction in inflammation markers as CRP and hepcidin without any negative impact on albumin levels.