| 特集名 | 血液透析効率の評価法について再考する | |
|---|---|---|
| 題名 | 透析効率に及ぼす各種影響因子（3）ダイアライザ性能の経時変化 | |
| 発刊年月 | 2010年 04月 | |
| 著者 | 崎山 亮一 | 東京女子医科大学臨床工学科 |
| 著者 | 峰島 三千男 | 東京女子医科大学臨床工学科 |
| 【 要旨 】 | 近年，膜性能の向上により透水性能や溶質除去能の高いダイアライザが開発されている．しかし高性能ダイアライザほど，ファウリング（膜への蛋白付着）により膜性能の経時減少が懸念されている．本報告では，膜性能の経時変化についてわれわれが施行した牛血系in vitro実験と臨床評価の結果を紹介する．in vitro実験の結果，内部濾過量は経時的に低下し，大分子溶質であるα1-ミクログロブリン（MG）クリアランスは開始2時間で低下し，アルブミンクリアランスは開始20分で消失した．臨床では，膜間圧力差（TMP）が経時的に上昇し透水性が低下したため，内部濾過量も低下した．膜性能の経時変化はファウリングの影響により，内部濾過のみならず溶質透過へも影響を及ぼす．膜性能の経時変化を考慮した治療を個々の患者に施行する必要がある． | |
| Theme | Performance Evaluations for Blood Purification Devices and Characteristics of Dialysis Adequacy Indices | |
|---|---|---|
| Title | Time related of dialyzer performance reduction | |
| Author | Ryoichi Sakiyama | Department of Clinical Engineering, Tokyo Women's Medical University |
| Author | Michio Mineshima | Department of Clinical Engineering, Tokyo Women's Medical University |
| [ Summary ] | Several kinds of high-flux dialyzers have been developed to improve solute removal efficiency and water permeability for hemodialysis therapy. The performance of those dialyzers, however, often decreases with time due to membrane fouling, namely protein plugging to the membranes. The rate of reductions in dialyzer performance in high-flux dialyzers was evaluated during a bovine in vitro study and a clinical study. As a result, internal filtration rates (QIF) and clearance of large molecular weight substances such as those being α1-MG in size and albumin gradually decreased with time up to 120 min after the start of the experiments in the in vitro study. These results were induced by membrane fouling, but the effects on solute transport through the membrane were different in various solutes. In a clinical study, increases in TMP and decrease in QIF over time were observed to be similar to those observed in the in vitro study. High flux dialyzers should be used for individual patients in consideration their reduced performance over time. |
|