Individualized reduction in dialysate sodium in conventional in-center hemodialysis
Individualized reduction in dialysate sodium in conventional in-center hemodialysis
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DOI：
10.1111/j.1542-4758.2012.00701.x
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发表时间：
2012-10-01
影响因子：
1.3
通讯作者：
Schiller, Brigitte
中科院分区：
文献类型：
--
作者：
Arramreddy, Rohini;Sun, Sumi J.;Schiller, Brigitte
最近的研究集中在透析液钠（Na+）处方与透析间期体重增加（IDWG）之间的相关性。我们报告了一个病例系列的13例患者接受常规，每周三次的中心血液透析与个性化的透析液钠+处方。通过每周逐步减少标准透析液Na+处方（140？mEq/L），23？mEq/L，直至达到Na+梯度-2？mEq/L（透析液Na+减去前3个月的平均血浆Na+）。透析间期体重增加，伴或不伴干重指数（IDWG%），血压，以及痉挛、透析中低血压（收缩压下降>30？mmHg）和需要干预的透析中低血压。在观察期开始时，血液透析前（HD）血浆Na+浓度范围为130至141？mEq/L。当从标准透析液Na+浓度转换为个体化透析液Na+浓度时，IDWG%从3.4%+/-？1.6%至2.5%？+/-？1.0%（P <0.01）。0.003），而HD前后收缩压或舒张压无变化（均P？0.05）。我们发现，痉挛（6% vs. 13%）、透析中低血压（62% vs. 65%）或需要干预的透析中低血压（29% vs. 33%）的治疗比例无显著变化。透析液Na+的个体化减少可降低IDWG%，而不会显著增加痉挛或低血压的频率。
Recent studies have focused on the association between dialysate sodium (Na+) prescriptions and interdialytic weight gain (IDWG). We report on a case series of 13 patients undergoing conventional, thrice-weekly in-center hemodialysis with an individualized dialysate Na+ prescription. Individualized dialysate Na+ was achieved in all patients through a stepwise weekly reduction of the standard dialysate Na+ prescription (140?mEq/L) by 23?mEq/L until reaching a Na+ gradient of -2?mEq/L (dialysate Na+ minus average plasma Na+ over the preceding 3 months). Interdialytic weight gain, with and without indexing to dry weight (IDWG%), blood pressure, and the proportion of treatments with cramps, intradialytic hypotension (drop in systolic blood pressure >30?mmHg) and intradialytic hypotension requiring an intervention were reviewed. At the beginning of the observation period, the pre-hemodialysis (HD) plasma Na+ concentration ranged from 130 to 141?mEq/L. When switched from the standard to the individualized dialysate Na+ concentration, IDWG% decreased from 3.4%?+/-?1.6% to 2.5%?+/-?1.0% (P?=?0.003) with no change in pre- or post-HD systolic or diastolic blood pressures (all P?>?0.05). We found no significant change in the proportion of treatments with cramps (6% vs. 13%), intradialytic hypotension (62% vs. 65%), or intradialytic hypotension requiring an intervention (29% vs. 33%). Individualized reduction of dialysate Na+ reduces IDWG% without significantly increasing the frequency of cramps or hypotension.