A case in which the sudden onset of dysdialysis was improved using a high-pressure steam-sterilized PS membrane

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  • 突然発症した透析困難症を高圧蒸気滅菌PS膜の使用で改善できた1症例
  • 症例報告 突然発症した透析困難症を高圧蒸気滅菌PS膜の使用で改善できた1症例
  • ショウレイ ホウコク トツゼン ハッショウ シタ トウセキ コンナンショウ オ コウアツ ジョウキ メッキン PSマク ノ シヨウ デ カイゼン デキタ 1 ショウレイ

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Abstract

<p>This case involved a 75-year-old male with a 17-year history of dialysis. We have been performing online hemodiafiltration (HDF) with γ-sterilized polysulfone (PS) membranes for 2 years. The patient’s treatment followed a stable course, but at some point his systolic blood pressure dropped to 70 mmHg just after the onset of HDF, resulting in dysdialysis with dysphoria. First of all, incompatibility with the PS membrane was suspected so the membrane material was changed to cellulose triacetate or ethylene vinyl alcohol copolymers (both γ-ray sterilized membranes), but no improvement was achieved. We also changed the anticoagulant, but this did not ameliorate the dysdialysis. Furthermore, an ultrafiltration rate of 0 mL/hr and extracorporeal ultrafiltration methods were also tested at the start of treatment, but it was not possible to prevent reductions in blood pressure. The blood volume (BV) waveform was monitored during dialysis with a BV meter, and an abnormal waveform, which rose just after the start of treatment, was detected, and it was judged that the patient’s vascular permeability had increased due to incompatibility with the membrane. When the membrane was changed to a high-pressure steam-sterilized PS instead of a γ-ray sterilized membrane, the reduction in blood pressure and dysphoria disappeared, and the BV waveform also normalized. In this case, the dialyzer sterilization method was important, as changing the membrane to the same type of material, but using a different sterilization method, was effective. In addition, monitoring the BV waveform was useful for judging the effects of changing the treatment conditions.</p>

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