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Kinetics of β-2-Microglobulin with Hemodiafiltration and High-Flux Hemodialysis
Clinical Journal of the American Society of Nephrology ( IF 9.8 ) Pub Date : 2024-04-23 , DOI: 10.2215/cjn.0000000000000461
Richard A. Ward 1 , John T. Daugirdas 1
Affiliation  

for β-2-microglobulin removal and generation was used to explore the impact of adding hemodiafiltration on predialysis and time-averaged serum values. Methods The model was tested on data from the HEMO study and on a sample of patients undergoing high-flux hemodialysis. The impact of hemodiafiltration on β-2-microglobulin levels was evaluated by modeling four randomized studies of hemodiafiltration versus hemodialysis. The impact of residual kidney function on β-2-microglobulin was tested by comparing results of previously reported measured data with model predictions. Results In the low-flux and high-flux arms of the HEMO study, measured median β-2-microglobulin reduction ratios could be matched by dialyzer clearances of 5.9 and 29 ml/min, respectively. Median predialysis serum β-2-microglobulin levels were matched if generation rates of β-2-microglobulin were set to approximately 235 mg/d. In another group of patients treated with dialyzers with increased β-2-microglobulin clearances, measured cross-dialyzer clearances (57±28 ml/min) were used as inputs. In these studies, the kinetic model estimates of intradialysis and early postdialysis serum β-2-microglobulin levels were similar to median measured values. The model was able to estimate the changes in predialysis serum β-2-microglobulin in each of four published randomized comparisons of hemodiafiltration with hemodialysis, although the model predicted a greater decrease in predialysis serum β-2-microglobulin with hemodiafiltration than was reported in two of the studies. The predicted impact of residual kidney clearance on predialysis serum β-2-microglobulin concentrations was similar to that reported in one published observational study. Modeling predicted that postdilution hemodiafiltration using 25 L/4 hours replacement fluid would lower serum time-averaged concentration of β-2-microglobulin by about 18.2%, similar to the effect of 1.50 ml/min residual kidney GFR. Conclusions A two-pool kinetic model of β-2-microglobulin yielded values of reduction ratio and predialysis serum concentration that were consistent with measured values with various hemodiafiltration and hemodialysis treatment regimens....

中文翻译:


血液透析滤过和高通量血液透析中 β-2-微球蛋白的动力学



用于 β-2-微球蛋白去除和生成的方法用于探讨添加血液透析滤过对透析前和时间平均血清值的影响。方法 根据 HEMO 研究的数据和接受高通量血液透析的患者样本对该模型进行了测试。通过对血液透析滤过与血液透析的四项随机研究进行建模,评估了血液透析滤过对 β-2-微球蛋白水平的影响。通过将先前报道的测量数据的结果与模型预测进行比较,测试了残余肾功能对β-2-微球蛋白的影响。结果 在 HEMO 研究的低通量和高通量组中,测得的中位 β-2-微球蛋白减少率可以分别与 5.9 和 29 ml/min 的透析器清除率相匹配。如果 β-2-微球蛋白的生成率设置为约 235 mg/d,则透析前血清 β-2-微球蛋白中位水平相匹配。在另一组使用β-2-微球蛋白清除率增加的透析器治疗的患者中,测量的跨透析器清除率(57±28ml/min)被用作输入。在这些研究中,透析中和透析后早期血清 β-2-微球蛋白水平的动力学模型估计值与中位测量值相似。该模型能够估计四项已发表的血液透析滤过与血液透析的随机比较中每一项的透析前血清 β-2-微球蛋白的变化,尽管该模型预测血液透析滤过的透析前血清 β-2-微球蛋白的下降幅度比两个报告中报道的要大。的研究。残余肾清除率对透析前血清 β-2-微球蛋白浓度的预测影响与一项已发表的观察性研究中报告的结果相似。 模型预测,使用 25 L/4 小时置换液进行稀释后血液透析滤过将使 β-2-微球蛋白的血清时间平均浓度降低约 18.2%,类似于 1.50 ml/min 残余肾 GFR 的效果。结论 β-2-微球蛋白的双池动力学模型产生的减少率和透析前血清浓度值与各种血液透析滤过和血液透析治疗方案的测量值一致。
更新日期:2024-04-23
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