ゼロナトリウム溶液を用いた腹腔内直接ナトリウム除去に関する初体験:体積過負荷に対する新たな治療候補
Veena S Rao1, Jeffrey M Turner2, Matthew Griffin1
1Department of Internal Medicine, Section of Cardiovascular Medicine (V.S.R., M.G., D.M., N.B., J.M. Testani), Yale University School of Medicine, New Haven, CT.
Circulation
|January 9, 2020
まとめ
無ナトリウム溶液を用いた直接ナトリウム除去 (DSR) は,臨床前およびヒト試験において,かなりの量のナトリウムを効果的に除去しました. この新しいアプローチは 心不全患者の 過剰な体液管理に有望です
科学分野:
- 腎臓科
- 心臓病科
- 生物医学工学
背景:
- 循環性尿薬は心不全 (HF) で一般的ですが,毒性があり,有効性が失われる可能性があります.
- HFの患者でエヴォレミアを維持するには,別の戦略が必要である.
- 腹腔膜経由の直接ナトリウム除去 (DSR) は,ナトリウムフリーオスモティック溶液による腎臓以外のナトリウム抽出方法を提供します.
研究 の 目的:
- DSRの臨床前進行を記述する.
- DSRの概念を 人間で初めて証明する
- 液体の過負荷管理におけるDSRの安全性,有効性,および拡張性を評価する.
主な方法:
- 豚の臨床前研究では,10%のデクストロース溶液を用いてDSRを調査し,実験的な心不全における停留時間,安全性,およびスケーラビリティを評価した.
- 腹腔透析 (PD) を受けている末期腎疾患の患者をランダム化してDSRまたは標準PDに移した概念実証試験.
- 主要エンドポイントは耐性であり,次要エンドポイントはナトリウム除去の差でした.
主要な成果:
- 豚の試験では,安定した電解質と最小限の非標的溶液の除去で,DSRで2時間で4. 1gのナトリウムが除去されたことが示されました.
- 豚の体積が増加すると,ナトリウム除去が強化され,血体積が減少した.
- 人体での研究では,DSRは良好に耐受され,標準PDよりもかなり多くのナトリウム (4. 5g対1. 0g) が除去され,安定した電解質と軽微な非標的溶液の除去が示されました.
結論:
- 直接のナトリウム除去 (DSR) は,動物とヒトではよく許容されます.
- 標準の腹腔内透析と比較して,DSRは実質的により多くのナトリウム除去を達成しました.
- 心不全における高血量症の予防と治療のためのDSRを評価するために,さらなる研究が必要である.
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