Effect of the super-flux cellulose triacetate dialyser membrane on the removal of non-protein-bound and protein-bound uraemic solutes.

BACKGROUND: Uraemic solutes accumulate in haemodialysis (HD) patients and interfere with physiological functions. Low-flux (LF) HD does not efficiently remove all uraemic compounds. We investigated whether large pore super-flux (SF) cellulose triacetate membranes (CTA) result in a better removal of uraemic solutes. METHODS: Eleven patients were dialysed consecutively with LF-CTA and SF-CTA during 3 weeks. Urea (UR), creatinine (CR), uric acid (UA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), indole-3-acetic acid (IAA), indoxyl sulfate (IS), hippuric acid (HA), pentosidine (PENT), low-molecular weight (MW) AGEs (AGEs) and albumin were determined in pre-HD, post-HD blood and in dialysate. Reduction rate (RR), dialytic clearance and mass transfer-area coefficient (KoA) were calculated. RESULTS: SF-HD resulted in a higher RR than LF-HD for IS and AGEs. Urea RR correlated with HA (r=0.59), IS (r=0.68) and IAA (r=0.67), (P<0.05) for SF. Dialytic clearance ranged from 20+/-5 to 179+/-20 ml/min for LF and from 24+/-6 to 191+/-24 ml/min for SF; being higher with SF for UA, HA, IS and IAA (SF vs LF, P<0.05). KoA was higher for most compounds with SF-HD. Albumin loss per SF session was 3.4+/-1.3 g. The retrieved amount of uraemic solutes in dialysate with LF and SF was comparable. CONCLUSIONS: In conventional HD, SF-CTA was superior to LF-CTA for removal of most protein-bound compounds, especially IS. Reduction rate, dialytic clearance and KoA were higher with SF. The SF-CTA membrane is albumin-leaking; however, this property could not completely explain the amount of retrieved protein-bound compounds in dialysate.     

长期应用不同钙离子浓度透析液对血液透析患者血压影响的对照研究

目的 探讨长期应用不同钙离子浓度透析液对维持性血液透析患者血压的影响。方法对近期无低血压发生的15例维持性血液透析患者首先给予钙离子浓度为1．75mmol／L（Dcal．75）的透析液治疗6个月，然后接受钙离子浓度为1．25mmol／L（Dcal．25）的透析液治疗6个月。检测两种透析液单用治疗前以及治疗后1、2、3和4h血清钙、磷、尿素氮和肌酐水平，并记录血压变化。结果 使用Dcal．25透析液单次透析治疗4h，患者的收缩压和舒张压均较透析前下降（P均〈0．05），收缩压较舒张压下降更明显（P〈0．05）；而接受Dcal．75透析液治疗的患者收缩压和舒张压均较透析前升高（P均〈0．05），收缩压较舒张压升高更明显（P〈0．05）。收缩压、舒张压和平均血压与血清总钙的变化均呈正相关（r1=0．326，P1=0．054．r2=0．383，P2=0．037．r3=0．391，P3=0．032）。使用Dcal．25透析液治疗6个月，患者收缩压和舒张压均有所下降，但差异均无显著性（P均〉0．05）；使用Dcal．75透析液治疗6个月，患者血压有所升高，其中收缩压升高显著（P〈0．05）。两种钙离子浓度透析液长期治疗引起的收缩压变化相比差异有显著性（P〈0．05）。结论 单次应用低钙透析可明显降低收缩压，减少高血压的发生率。     

低钙透析液对维持性血液透析患者钙磷代谢及甲状旁腺激素的影响

目的探讨低钙透析液对非低钙血症维持性血液透析患者的钙磷代谢以及甲状旁腺激素的影响。方法将60例非低钙血症维持性血液透析患者随机分为观察组与对照组,观察组采用低钙透析液(Ca~(2+)浓度为1.25 mmol/L),对照组采用常规透析液(Ca~(2+)浓度为1.50 mmol/L),比较2组患者的疗效。结果治疗后,观察组患者血清T-Ca、T-Ca×P显著下降,血清i PTH显著升高(P0.05);对照组患者血清T-Ca、T-Ca×P显著升高,血清i PTH显著下降(P0.05)。观察组患者血清T-Ca、T-Ca×P均显著低于对照组,血清i PTH均显著高于对照组(P0.05)。治疗6个月后,观察组患者血清hs-CRP显著低于对照组(P0.05)。2组患者不良反应发生率无显著差异(P0.05)。结论非低钙血症维持性血液透析患者应用低钙透析液可以降低血清高钙负荷,改善甲状旁腺过度抑制状态与心血管炎症状态。     

长期使用Ca~+1.25mmol/L透析液对维持性血液透析患者矿物质代谢的影响

目的观察长期应用钙离子浓度为1.25mmol/L的低钙透析液(low calcium dialysate,LCa D)对维持性血液透析患者(maintained hemodialysis,MHD)矿物质代谢的影响。方法选择进行血液透析治疗3个月以上的慢性肾衰竭患者50例,分别观察应用低钙透析液3,6,9个月后钙磷,甲状旁腺激素的变化。结果应用1.25mmol/L的低钙透析液透析后不同血钙水平的组别及不同i PTH水平的组别血钙浓度均有明显下降。整体观察血磷在低钙透析3,6个月时无明显改变,9个月时有明显下降(P0.05)。血i PTH多在低钙透析3个月时无明显改变,应用至6,9个月后有明显升高(P0.05)。结论低钙透析可降低部分血液透析患者血钙水平,使得血磷更易控制;但同时可能加重SHPT,需同时合理使用钙剂及活性维生素D。     

我国腹膜透析患者充分透析剂量的理论探讨

目的：探讨腹膜透析(PD)患者充分透析剂量以及通过降低透析剂量达到降低透析成本的可行性。方法：应用尿素动力学原理，在氮平衡的基础上对PD患者透析剂量进行推算。结果：透析剂量取决于患者蛋白质摄入量及体重；残余肾功能对透析剂量有很大影响。当残肾功能为零时，相同体重患者随着每天蛋白质摄入量(DPI)增加，其透析剂量也相应的增加；当DPI一定时，残肾功能低者，其采用的透析剂量大。结论：我国PD患者维持氮平衡状态时蛋白质的摄入量低于西方人，且体重较轻，在此基础上所需的理论透析剂量较西方传统的透析剂量低，理论上通过降低透析剂量达到降低透析成本的目的是可行的，保全残肾功能可以降低透析剂量。     

慢性肾功能不全腹膜透析患者透出液CA125检测的临床意义

目的探讨检测慢性肾功能不全腹膜透析患者透出液CA125水平的临床意义。方法选择2007年5月至2014年6月慢性肾功能不全腹膜透析患者76例为研究对象,其中合并腹膜炎患者36例为治疗组,未合并腹膜炎患者40例为对照组。采用酶联免疫吸附测定(ELISA)法检测透出液CA125水平,并采用4 h腹膜平衡试验(4h D/Pcr)评估腹膜转运功能及其与CA125水平的关系。结果治疗前,治疗组患者透出液CA125水平为(49.51±17.21)×103U·L-1,对照组患者为(11.41±9.24)×103U·L-1,2组比较差异有统计学意义(P<0.01);治疗组患者腹膜炎治愈后1个月透出液CA125水平为(14.72±10.32)×103U·L-1,与治疗前比较差异有统计学意义(P<0.01),与对照组患者比较差异无统计学意义(P>0.05)。腹膜高转运者、高平均转运者、低平均转运者、低转运者透出液CA125水平比较差异无统计学意义(F=1.412,P>0.05);Spearman直线相关分析显示4h D/Pcr与CA125水平无明显的相关性(r=0.004 8,P>0.05)。结论透出液CA125水平能够反映慢性肾功能不全腹膜透析患者腹膜间皮细胞的数量及其功能。慢性肾功能不全行持续非卧床腹膜透析治疗患者透出液CA125水平的变化,对于判断腹膜炎的预后、评价腹膜转运功能均有一定的临床价值。     

Substitution of Acetic Acid for Hydrochloric Acid in the BicarbonateBuffered Dialysate

Abstract: In a multicenter study including 5 dialysis units, blood acetate changes during 4 h dialysis sessions in 141 patients treated with a 4 mM acetate-containing bicarbonate dialysate (ABD) were evaluated and compared to the values of 114 patients using an acetate-free bicarbonate dialysate (AFD). Acetate-free bicarbonate dialysate was delivered by a dialysis machine from the mixing with water for dialysis of a 1/26.2 bicarbonate concentrate, and a 1/35 acid-concentrate in which acetic acid was substituted for hydrochloric acid (Soludia, Fourquevaux, France). This new type of dialysate was routinely in use for 3 years on average (range, from 2 to 5 years). All patients fasted before and during dialysis. Blood samples were withdrawn at the start and at the end of dialysis sessions. The acetate plasma concentration was determined using the acetyl-CoA synthetase enzymatic method (Boehringer, Manheim, Germany). In patients treated with ABD whose predialysis blood acetate levels were in the physiologic range of ≤100 μM (n = 113), the acetate plasma concentration increased from a predialysis mean value of 22 ± 3 μM to a postdialysis mean value of 222 ± 11 μM in 88 patients (78% of patients) whereas the acetate plasma concentration changes remained in the range of physiologic values from 21 ± 6 to 58 ± 7 μM in the other 25 patients. In contrast, patients treated with AFD whose predialysis blood acetate levels were in the physiologic range (n = 108), acetate plasma concentration increased from a predialysis mean value of 49 ± 6 μM to 160 ± 19 μM in only 13 patients (12% of patients) whereas acetate plasma concentration changes remained in the range of physiologic values of 23 ± 2 to 41 ± 3 μM in most of the patients of this group. In this study, a significant number of patients, whether receiving standard or acetate-free bicarbonate dialysates, exhibited an extremely high acetate plasma concentration at the start of the dialysis session. Hyperacetatemia was controlled with AFD in patients whose predialysis acetate plasma concentration of 316 ± 82 decreased to 55 ± 23 μM (n = 6) at the end of the dialysis session whereas the acetate plasma concentration remained high when the predialysis concentration was 580 ± 76 μM, with a postdialysis concentration of 233 ± 39 μM (n = 28). It is concluded that in patients whose predialysis blood acetate levels were in the physiologic range, acetate-containing bicarbonate dialysate induces hyperacetatemia whereas postdialysis blood acetate remains in the normal range in such dialysis patients treated with acetate-free dialysate. Chronic hyperacetatemia, which could be found in dialysis patients, is well controlled by dialysis using an acetate-free dialysate.     

Pancreatitis Causes Brownish-Black Peritoneal Dialysate Due to the Presence of Methaemalbumin

Two patients treated with continuous ambulatory peritoneal dialysishad striking brownish-black coloured peritoneal dialysate concomitantwith underlying pancreatitis. Examination of the second patient'sdialysate by recording spectrophotometry showed the discolorationto be due to methaemalbumin. Haemorrhagic pancreatitis, by releasingproteolytic enzymes and perhaps by using the lesser sac as ananatomical cul-de-sac for chemical reaction, provides a suitablemilieu for the production of methaemalbumin from red blood cellsin dialysate.