透析患者の貧血に対する長期蛋白漏出性血液透析 (PPHD) の効果

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  • Long-term clinical effects of protein permeable hemodialysis (PPHD) on the anemia in the patients undergoing maintenance hemodialysis

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To evaluate the effect and the mechanism of action of PPHD on the anemia in patients undergoing maintenance hemodialysis, serial measurements of hematocrit and other hematological parameters were performed in PPHD group (n=15) and regular HD group (n=15). Fifteen patients who received PPHD had either drug-resistant anemia or HD amyloidosis. In the PPHD group, improvement of anemia was recongnized in 7 of 15 patients (47%), and the blood transfusion rate was significantly reduced from 0.26±0.38 to 0.08±0.15 units/month/person (p<0.05).<br>The hematocrit rose from 22.1±3.9 to 24.9±3.9% (p<0.05) after 5 months of treatment. Total protein rose from 6.3±0.6 to 6.5±0.5g/dl (p<0.05). There were no significant changes in iron metabolism, or the serum levels of β2-microglobulin, PTH, aluminum and small molecular substances. Seven patients who had elevations of hematocrit in the PPHD group showed significant rises in serum creatinine, total protein and total calcium with a concomitant decrease in serum aluminum level. However, there was no significant correlation between hematocrit and serum aluminum level. There was a surface area-dependent rise in hematocrit when remarkable improvement in anemia occurred after introduction of PPHD. From these results, PPHD seems to be effective in: improving anemia in patients undergoing maintenance hemodialysis.<br>Uremic toxin (s) from the middle molecular range to the large molecular range might be more important than well-known uremic toxins such as β2-microglobulin, PTH and aluminum.

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