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Comparison of dialysis programmes on different molecular prescriptions: a preliminary study
Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association
|January 1, 1977
Summary
Dialysis and adsorbent therapies should prioritize removing toxic small molecular fractions, not just middle ones. Efficiently removing middle molecules while retaining small ones worsens biological toxicity and patient outcomes.
Area of Science:
- Nephrology
- Biochemistry
- Toxicology
Background:
- Dialysis and adsorbent therapies aim to remove waste products from blood.
- Understanding the differential toxicity of small and middle molecular weight uremic toxins is crucial for optimizing treatment.
Purpose of the Study:
- To compare the clinical effectiveness and biological toxicity of different dialysis and adsorbent therapy programs.
- To determine the relative toxicity of small versus middle molecular fractions in uremic patients.
Main Methods:
- Five different dialysis/adsorbent therapy programs were implemented.
- Ultrafiltrates were analyzed for blood urea nitrogen (BUN), creatinine, methylguanidine, enzyme inhibition (pyruvate kinase, G-6-PDH, LDH), and cell cytotoxicity.
- Hollow fiber filters with varying characteristics were used.
Main Results:
- Programs that efficiently removed middle molecules but retained small molecules showed the worst clinical outcomes.
- Small molecular fractions exhibited significantly higher biological toxicity than middle molecular fractions.
- Enzyme inhibition and cell mortality correlated with the presence of retained small molecules.
Conclusions:
- The biological toxicity of small molecular uremic toxins is clinically more significant than that of middle molecules.
- Therapeutic strategies should focus on the efficient removal of small molecular weight toxins.
- Prioritizing middle molecule removal over small molecule removal is counterproductive for maintaining the 'milieu intérieur'.