Vascular stability and clearance of large molecule substances

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  • Vascular stabilityおよび低分子量蛋白除去からみた適性透析

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Fewer symptoms and greater effectiveness are the important points in adequate dialysis. Vascular stability and the ability to remove low molecular weight proteins were investigated during hemodialysis. Colloid osmotic pressure, serum osmotic pressure and plasma catecholamine concentration were measured in patients during the various modes of hemodialysis, including a dialysate with a sodium concentration of 138 or 145mEq/l or with 45 mM glycerol concentration. Plasma catecholamine levels before and after treatment were also compared in cold (34°C) and warm (37°C) dialysate dialysis. The changes in colloid osmotic pressure before and after treatment were smaller in 145mEq/l sodium or glycerol dialysate dialysis than with 138mEq/l sodium dialysis. These data could be explained by the plasma refilling effect of high sodium or glycerol. Cold dialysate dialysis showed a smaller decrease in plasma catecholamine during treatment than the other three modes of dialysis, even though all of them gave the same catecholamine clearance. This indicates that “cold” dialysis might have a greater stimulation for the adrenergic drive, which contributed to vasuclar stability. The rate of removal of β2-microglobulin and protein was much greater in the polysulfone artificial kidney (PSAK) than in another conventional membrane dialyzer. The plasma concentration of β2-microglobulin gradually decreased with the continuous use of PSAK, this increase could not be observed with the other dialyzer. Immunoelectrophoretic analysis revealed that the protein in the dialysate that passed through PSAK had a pattern similar to that in the peritoneal drainage of a patient with CAPD. These data indicate that dialysis using a proteinleaking membrane such as PSAK is similar to CAPD treatment which has a greater clearance for large molecule substances.<br>We conclude that the dialysis with a 145mEq/l sodium-or glycerol-containing dialysate and/or cold dialysate dialysis have greater advantages in vascular stability during dialysis. In addition to this modification of the dialysate, the use of a protein-leaking membrane seems to provide more effective dialysis with fewer symptomats.

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