RESUMEN
OBJEVTIVE: To evaluate the peritoneal clearance of the middle molecule compared with that of the small molecule in incremental peritoneal dialysis(PD). METHODS: Peritoneal clearances of the creatinine and beta2-microgloblulin were compared in 57 continuous ambulatory PD patients with full dose 4 times exchange and in 54 incremental PD patients with 2 or 3 times exchange over 24 hours. The clearances were also compared when there were changes in the peritoneal dialysis regimen such as in the number of exchanges and dwelling time. RESULTS: Peritoneal creatinine clearance increased almost linearly along with the increase in the number of exchanges. In contrast, peritoneal clearance of beta2-microglobulin was 9.1+/-3.6 L/week, 8.8+/-4.4 L/ week, and 7.9+/-2.5 L/week respectively with 2, 3 and 4 exchanges per day, not different from each other. Peritoneal clearance of beta2-microglobulin did not change when there was an increase in the number of exchange from 2 to 3 times and 3 to 4 times over a period of 24 hours, whereas the peritoneal clearance of creatinine increased. Peritoneal clearance of beta2-microglobulin almost doubled from 5.4+/-2.7 L/ week with 2 times exchange over 12 hours per day, to 9.5+/-4.4 L/week with 2 times exchange over 24 hours, whereas the creatinine clearance did not change. CONCLUSION: In contrast to peritoneal clearance of small molecule which depends on the number of dialysate exchange, peritoneal clearance of middle molecule depends mainly on the total dwelling hours rather than the number of exchange per day in incremental PD. This can be another advantage of incremental PD since peritoneal clearance of middle molecules in incremental PD over 24 hours is comparable to that in full dose PD.
Asunto(s)
Humanos , Creatinina , Diálisis PeritonealRESUMEN
In this study, authors observed and compared the clearances of different molecule weight substances between different dialysis membranes and different hemopurification methods. The results showed that the clearances of BUN by hemodialysis (HD) with cuprophan membrane, hemodiafiltration (HDF) with polysulfone and high flux dialysis (HFD) with polysulfone were all satisfactory. TACurea were all below 50 mg. Hemodialysis with cuprophan could clean out some middle molecule substances (MMS), but not ?2-microglobulin (?2m). Hemodiafiltration with polysulfone had the best clearances of MMS and ?2m. Hemofiltration (HF) with polysulfone had fair clearances of MMS and ?2m, but the clearances of BUN and Cr by HF were not so good. The clearances of MMS and ?2m by high flux dialysis were lower than those of HDF and HF. The clearances of MMS and ?2m by continuous ambulatory peritoneal dialysis (CAPD) at a single time were lower than those of HF, HDF and HFD, but the general clearances of MMS and ?2m by CAPD per week were two to four times higher than those by hemodialysis with cuprophan. CAPD is a choice method for those hospitals where HF or HDF can not be performed.
RESUMEN
The effect of plasma middle molecule substances (MMS) on the Ca2+-ATPase activity in human erythrocyte membranes was studied. The results showed that the Ca2+-ATPase activity was significantly inhibited when the membrane preparation was incubated with MMS at 37℃. The longer the period of time for incubation, the lower the Ca2+-ATPase activity. The activity of Ca2+-ATPase could be significantly inhibited by plasma MMS of both normal person and burn patient. The inhibitory rate (%) of Ca2+-ATPase activity was elevated markedly when MMS concentration was increased (P