各種血液浄法 (hemodialysis, hemofiltratim, sodium gradient methodおよびcell wash dialysis) における血漿, 赤血球内urea-N, creatinine, guanidino compoundsの変動

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  • Changes in urea-N, creatinine and guanidino compounds in plasma and blood cells during blood purification (HD, HF, SGM, CWD)

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The removal and reduction rates of urea-N, creatinine and guanidino compounds in plasma and red blood cells (RBC) were examined during the course of hemodialysis (HD), hemofiltration (HF), sodium gradient method (SGM) and cell wash dialysis (CWD) in patients on maintenance hemodialysis.<br>Concentrations before blood purification were as follows: plasma Na, 137±3mE/l; RBC Na, 10.3±2.9mEq/l; plasma K, 4.1±0.9mEq/l; RBC K, 106.3±4.9mEq/l; plasma urea-N, 62±16mg/dl; RBC urea-N, 55±13mg/dl; plasma creatinine, 10.7±2.3mg/dl; RBC creatinine, 10.2±1.9mg/dl; plasma GSA, 14.9±5.9μM/l; RBC GSA, 4.8±2.7μM/l; plasma GAA, 3.6±1.4μM/l; RBC GAA, 3.7±1.7μM/l; plasma G, 4.1±1.8μM/l; RBC G, 8.5±2.9μM/l; plasma MG, 4.1±1.8μM/l; RBC MG, 6.2±2.6μM/l.<br>Accumulation of urea-N and creatinine in RBC was not observed before purification, whereas that of G and MG was.<br>The removal rate of plasma urea-N and creatinine during each type of blood purification (HD, HF, SGM, CWD) was as high as 50-80%.<br>However, the removal rate of G and MG was slightly low, falling in the range of 40-70%. Although the removal rate of urea-N and creatinine in RBC was 30-70%, that of and MG was as low as 8-30%.<br>The removal rate of RBC uremic toxins in the high sodium phase of CWD was not advantageous as compared to the other methods.<br>The reduction rate of plasma urea-N and creatinine before and after each type of blood purification was 40-70%, which was satisfactory; however, the reduction rate of and MG was as low as 30-40%.<br>Although the reduction rate of RBC urea-N and creatinine was 40-60%, that of of G and MG was as low as 20-30%.<br>By examining the ratio of the reduction rates of uremic toxins in RBC and in plasma, it was found that HF was effective to removal G and M in these cells.

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