nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2009-13-2-50-54nefr-1162Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОН - ЛАЙН ГЕМОДИАФИЛЬТРАЦИЯ С АЦЕТАТОМ И БЕЗ НЕГОON - LINE HAEMODIAFILTRATION WITH AND WITHOUT ACETATEПиццареллиФ.PizzarelliF.

Отделение нефрологии и диализа

Dr Francesco Pizzarelli, Head o f Nephrology Unit

Via dell’ Antella 58, 50011 Antella-Firenze, Italy

fpizzarelli@yahoo.comЦерраиТ.CerraiT.

Отделение нефрологии и диализа

Nephrology Unit

 

ДаттолоП.DattoloP.

Отделение нефрологии и диализа

Nephrology Unit

 

ФерроД.FerroG.

Отделение нефрологии и диализа

Nephrology Unit

 

SM Annunziata Hospital, ФлоренцияИталияSM Annunziata HospitalItaly2009100220091325054Copyright © Пиццарелли Ф., Церраи Т., Даттоло П., Ферро Д., 20092009Пиццарелли Ф., Церраи Т., Даттоло П., Ферро Д.Pizzarelli F., Cerrai T., Dattolo P., Ferro G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1162

ВВЕДЕНИЕ. У пациентов на он-лайн конвекционном лечении реинфузируется значительное количество диализирующего раствора. Небольшое количество ацетата, присутствующего в замещающем растворе как pH-стабилизирующий фактор может привести к попаданию значительного количества этого аниона пациенту с возможной активацией цитокинов. МЕТОДЫ. Для верификации этой гипотезы мы провели он-лайн гемодиафильтрацию (ОЛ-ГДФ) с 3 ммоль/л ацетата и без ацетата в диализирующем растворе двенадцати пациентам в перекрестном рандомизированном исследовании. РЕЗУЛЬТАТЫ. В сравнении с исходным уровнем, уровень ацетата плазмы был неизменным во время и после безацетатной ОЛ-ГДФ, тогда как процессе ОЛ-ГДФ с ацетатом он повысился в 5-6 раз в диализирующем растворе. Ацетат плазмы вернулся к базальном уровню через 2 часа по окончании процедуры. Общее повышение оснований у пациентов, получающих ОН-ГДФ с ацетатом составило 36%. Уровень бикарбоната плазмы в конце процедуры был значительно меньше при лечении без ацетата, в сравнении с получавшими ОЛ-ГДФ с ацетатом. Уровень интерлейкина-6 плазмы сравнивали в начале и в процессе процедуры и между двумя методами и была выявлена тенденция к большему повышению через 2 часа после ОЛ-ГДФ с ацетатом. ЗАКЛЮЧЕНИЕ. Наши предварительные результаты подтверждают предположение, что задержка ацетата в организме особенно высока при конвекционном лечении, тогда как безацетатная ОЛ-ГДФ снижает нагрузку ацетатом. Клинические преимущества этого предстоит оценить в последующих проспективных исследованиях.

BACKGROUND. In patients on on-line convective treatments, given the considerable quantity of dialysis fluid re-infused, the small amount of acetate present in bicarbonate dialysis fluid as a pH stabilizing factor may allow a significant transfer of that anion to the patient, possibly inducing cytokine activation. METHODS. To verify this hypothesis, we performed on-line haemodiafiltration (OL-HDF) with (3 mmol/l) and without acetate in dialysis fluid in a cross-over randomized order on 12 prevalent patients. RESULTS. In comparison with the pre-treatment values, plasma acetate levels were unchanged during and after acetate-free OL-HDF, while they were 5–6 times higher in the course of OL-HDF containing acetate in dialysis fluid; plasma acetate levels returned to basal values 2 h after the end of the procedure. The total increase of bases in the patient attributable to acetate was 36%. Plasma bicarbonate values at the end of treatment were significantly lower in treatments without acetate, as compared to those with acetate. Interleukin-6 plasma levels were super-imposable at the beginning and in the course of the two methods compared, but there was a tendency towards a greater increase at an interval of 2 h following OL-HDF with acetate. CONCLUSIONS. Our preliminary results confirm the assumption that body gain of acetate is particularly high in convective treatments, while acetate-free OL-HDF slows down acetate burden. Clinical advantages due to these effects should be evaluated in properly designed prospective studies.

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The authors declare that there are no conflicts of interest present.