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首页> 外文期刊>Kidney international. >Does convective dialysis therapy applied daily approach renal blood purification|[quest]|
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Does convective dialysis therapy applied daily approach renal blood purification|[quest]|

机译：对流透析疗法是否每天应用肾血液净化| [问] |

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Does convective dialysis therapy applied daily approach renal blood purification? Outcome studies in dialysis have generally failed to show an impact of changes in membrane flux or bio-compatibility, and only dose increases up to a certain level have been shown to improve survival significantly. However, to see an effect of a potentially improved dialysis treatment, all available factors that make dialysis more physiological may need to be combined. A membrane that mimics the glomerular basement membrane in being hemocompatible, having a high hydraulic permeability and a generous sieving, yet not leading to albumin loss could be used. The dialysis fluid composition could be individualized, and the quality and volume appropriate for the selected application. The new system of online-prepared ultrapure dialysis fluid and sterile infusion solutions, as integral parts of the treatment, are cost effective and labor saving as well as biocompatible. Ideally, we should select a blood purification method that covers the same range of solutes as the kidney. Convection is equally effective for all solutes that can pass through the membrane, and the corresponding renal therapy is hemofiltration. For enhanced small solute removal, convection can be combined with diffusion as in hemodiafiltration, which has the potential to achieve the largest solute removal over a wide molecular weight spectrum among all forms of dialysis. Finally, the dialysis treatment should be applied as often as is practically possible–preferably daily–in order to reduce the peaks caused by uremic toxins, the exposure to acidosis and alkalosis, and the burden on the cardiovascular system by overhydration. While the designed therapy is already technically feasible today, a positive result from outcome studies will be needed to bring about the political and economic decisions required to change conventional dialysis into a treatment approaching true renal blood purification.
机译：对流透析疗法是否每天都用于肾血液净化？透析的结果研究通常未能显示出膜通量或生物相容性变化的影响，仅显示剂量增加到一定水平才能显着提高生存率。然而，为了看到可能改善透析治疗的效果，可能需要结合使透析更具生理性的所有可用因素。可以使用模仿肾小球基底膜的血液相容性，具有高水力渗透性和大量筛分，但不会导致白蛋白损失的膜。透析液的成分可以个性化，其质量和体积适合所选应用。在线准备的超纯透析液和无菌输注溶液的新系统作为治疗的组成部分，不仅具有成本效益，节省了人工，而且具有生物相容性。理想情况下，我们应该选择一种血液净化方法，该方法可以覆盖与肾脏相同的溶质范围。对流对所有可穿过膜的溶质均有效，相应的肾脏疗法是血液滤过。为了提高少量溶质的去除，对流可以与血液透析滤过中的扩散相结合，在所有形式的透析中，都有可能在宽分子量范围内实现最大的溶质去除。最后，应尽可能多地（最好每天）应用透析治疗，以减少尿毒症毒素，酸中毒和碱中毒的暴露以及水合过度对心血管系统造成的负担。尽管今天设计的疗法在技术上已经可行，但仍需要结果研究的积极成果，才能做出将常规透析转变为接近真正的肾脏血液净化的疗法所需的政治和经济决策。

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