前半集中置換式血液透析ろ過療法による物質除去効率向上の検討

長岡 由女, 中尾 俊之, 松本 博, 岡田 知也, 韓 明基, 竹口 文博, 岩澤 秀明, 外丸 良, 和田 憲和, 権藤 麻子, 杉尾 眞由美, 尾形 明信, 後藤 和宏, 庭山 ゆう子

doi:10.4009/jsdt.38.1299

Hemodiafiltration (HDF) treatment is effective for removing low molecular weight proteins. To investigate whether the amounts of low molecular weight proteins removed could be increased by changing the filtration procedure using an equal amount of replacement fluid, we newly devised a first half intensive HDF that replaces 10L of fluids during the first 2 hours of a 4-hour treatment (HDF2), and compared this regimen with both conventional 4-hour hemodialysis (HD) and hemodiafiltration replacing 10L at a constant rate over 4 hours (HDF4). Each treatment was performed 8-9 times in a patient with end stage renal disease, and we measured the removal of β₂-microglobulin (β₂MG), α₁-microglubulin (α₁MG), urea, creatinine, phosphate and albumin, and the serum concentrations of these substances. The removed amounts and clear spaces of β₂MG and α₁MG were greater in HDF2 than in either HD or HDF4. Furthermore, albumin loss by HDF2 was also greater than that by either HD or HDF4. However, the amounts of urea, creatinine and phosphate removed did not significantly differ among HDF2, HD and HDF4. In HDF2, β₂MG and α₁MG were removed in a concentrated manner during the first 2 hours of the 4-hour treatment. This study suggested that removal of low molecular weight proteins depends on filtration speed rather than the amount of fluid replaced. In conclusion, this new method of HDF more effectively removed low molecular weight proteins than conventional constantly replacing HDF.

前半集中置換式血液透析ろ過療法による物質除去効率向上の検討

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前半集中置換式血液透析ろ過療法による物質除去効率向上の検討

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収録刊行物

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