Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis.
Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis.
复制标题
间歇性血液透析中的生物阻抗分析和透析中低血压。
DOI：
10.5414/cnp66039
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发表时间：
2006
影响因子：
1.1
通讯作者：
F. Strutz
中科院分区：
文献类型：
--
作者：
M. Koziolek;S. Gauczinski;E. Kahler;C. Bramlage;A. Scheel;G. Mueller;F. Strutz
背景
透析中低血压（IDH）是血液透析过程中最严重的并发症之一。它的出现部分是由于快速液体清除伴随血压调节失败，但也由其他透析依赖性和独立因素引起。
患者和方法
我们通过多频生物阻抗分析（BIA），研究了慢性间歇性血液透析透析易并发透析（CRF-HP，n = 11）和非易并发透析（CRF-NHP，n = 10）的终末期肾病患者在透析前、透析中每30分钟、透析后和透析中低血压发生时的总（TBW）、细胞外（ECW）和细胞内（ICW）。此外，观察了急性肾功能衰竭（ARF）和感染性休克患者（n = 10）中BIA的透析时间过程。
结果
IDH发生在72.1%的CRF-HP和80%的ARF患者中。在CRF-HP和CRF-NHP中，与透析前和透析后值相比，CRF-HP中ECW显著降低-12.44 +/- 4.22%，CRF-NHP中ECW显著降低-9.0 +/- 6.2%（均为p < 0.01）。相反，CRF-HP组ICW增加+11.5 +/- 11.3%，CRF-NHP组ICW增加+18.4 +/- 25.2%（均为p < 0.05）。在ARF患者中，未检测到显著变化。计算的ECW/ICW和ECW/TBW比值在CRF患者中显著降低，在CRF-HP患者中更高（p < 0.05）。ECW/ICW和ECW/TBW比值均与平均动脉压无关。透析中低血压的发生（n = 35）与血压正常的时期（n = 411）相比，在个体内没有差异。CRF患者的液体清除似乎主要来自细胞外间隙。与CRF-NHP相比，CRF-HP中ECW/ICW和ECW/TBW比值的降低减少可能表明CRF-HP中从内室到细胞外室的再充盈不足。
结论
总之，多频BIA不能预测特定透析期间个体患者的低血压。
BACKGROUND
Intradialytic hypotension (IDH) is one of the most severe complications during hemodialysis. Its appearance is caused in part by rapid fluid removal with concomitant failure in blood pressure regulation but also by other dialytic-dependent and independent factors.
PATIENTS AND METHODS
We investigated total (TBW), extracellular (ECW) and intracellular water (ICW) in chronic intermittent hemodialysis dialysis hypotension-prone (CRF-HP, n = 11) and nonhypotension-prone (CRF-NHP, n = 10) patients with end-stage renal disease before, every 30 minutes during, as well as after dialysis and within onset of intradialytic hypotension by multifrequent bioimpedance analysis (BIA). Additionally, intradialytic time course of BIA in patients with acute renal failure (ARF) and septic shock (n = 10) was observed.
RESULTS
IDH occurred in 72.1% of CRF-HP and in 80% of ARF patients. In CRF-HP and CRF-NHP, ECW significantly decreased by -12.44 +/- 4.22% in CRF-HP and -9.0 +/- 6.2% in CRF-NHP comparing pre- and post-dialysis values (each p < 0.01). Conversely, ICW increased by +11.5 +/- 11.3% in CRF-HP and +18.4 +/- 25.2% in CRF-NHP (each p < 0.05). In patients with ARF no significant changes could be detected. Calculated ECW/ICW and ECW/TBW ratio significantly decreased in CRF patients with a higher rate in CRF-HP patients (p < 0.05). Neither ECW/ICW nor ECW/TBW ratio correlated with mean arterial pressure. The onset of intradialytic hypotension (n = 35) did not differ intraindividually compared to normotensive periods (n = 411). Fluid removal in CRF patients seems to be mainly from the extracellular space. The reduced decreases in ECW/ICW and ECW/TBW ratios in CRF-HP compared to CRF-NHP may indicate an insufficient refilling from intra- to extracellular compartment in CRF-HP.
CONCLUSION
In conclusion, multifrequent BIA is not capable to predict hypotension in the individual patient during a particular dialysis session.