Daily ultrafiltration results in improved blood pressure control and more efficient removal of small molecules during hemodialysis.
Daily ultrafiltration results in improved blood pressure control and more efficient removal of small molecules during hemodialysis.
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每日超滤可改善血压控制并在血液透析过程中更有效地去除小分子。
DOI：
10.1159/000345334
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发表时间：
2012
影响因子：
3
通讯作者：
Cortell,Stanley
中科院分区：
文献类型：
--
作者：
Jones,JamesP;Leonard,EdwardF;Sandhu,Gagangeet;Winkel,Gary;Levin,NathanW;Cortell,Stanley
背景：尽管先前的研究表明，频繁的血液透析（HD）可以改善终末期肾病患者的干体重控制，但没有临床研究检查这是否可以改善血压（BP）控制，也可以缩短达到满意的小分子清除所需的透析时间。几种型号的可穿戴透析系统目前正处于不同的开发阶段。这些设备提供了血液透析患者达到其干重的可能性。我们已经建立了一个可穿戴超滤（UF）设备的原型，可以提供每日UF。除了更好的液体控制外，我们假设将HD与UF分开将导致更好的BP控制，并且可以在缩短透析持续时间的情况下实现足够的每周小分子清除。我们测试的假设，在目前的HD患者使用传统的透析equipment.Methods：13例患者被选中从一个大型的城市HD中心。实验期包括4周的每日超滤（4天/周的单独超滤和2天/周的HD+超滤）。HD疗程的持续时间增加15-30分钟，以维持每周标准Kt/V >2.0。然后，患者恢复其常规的3天/周HD伴UF，并研究4周。将实验期和恢复期的透析前BP、透析间期体重增加和Kt/V结果与3个月对照期的结果进行比较。结果：在实验期间，平均动脉压从110毫米汞柱下降到95毫米汞柱（p < 0.001），收缩压从158毫米汞柱下降到136毫米汞柱（p < 0.001），而透析间期体重增加从3.25升下降到1.21升（p < 0.0001）。在实验期间，每周标准Kt/V为2.16，在8.24小时/周的HD，相比11.14小时/week.Conclusions：容量控制与每日超滤结果改善BP控制，并通过分离的UF功能从HD，足够的每周标准Kt/V >2，可以实现每周两次HD。
Background:Although prior studies have shown that frequent hemodialysis (HD) can lead to improved control of dry weight in end-stage renal disease patients, there are no clinical studies examining whether this can improve blood pressure (BP) control and can also shorten the dialysis time needed to achieve satisfactory removal of small molecules. Several models of wearable dialysis systems are now under various stages of development. These devices present the possibility of hemodialyzing patients to their dry weights. We have built a prototype of a wearable ultrafiltration (UF) device that can provide daily UF. Apart from better fluid control, we hypothesize that separating HD from UF will result in better BP control, and adequate weekly small molecule removal could be achieved with a decreased duration of dialysis. We tested the hypothesis in current HD patients using conventional dialysis equipment.Methods:Thirteen patients were selected from a large urban HD center. The experimental period consisted of 4 weeks of daily UF (4 days/week of UF alone and 2 days/week of HD with UF). The duration of the HD sessions was increased by 15–30 min to maintain weekly standard Kt/V >2.0. The patients were then returned to their conventional 3 days/week of HD with UF and studied for 4 weeks. Predialysis BPs, interdialytic weight gains, and Kt/V results of the experimental and return periods were compared with those of the 3-month control period. No changes were made in antihypertensive or other medication during the study.Results:During the experimental period, mean arterial pressure decreased from 110 to 95 mm Hg (p < 0.001), systolic BP from 158 to 136 mm Hg (p < 0.001), while interdialytic weight gains were reduced from 3.25 to 1.21 liters (p < 0.0001). During the experimental period, weekly standard Kt/V of 2.16 was achieved in 8.24 h/week of HD, as compared to 11.14 h/week.Conclusions:Volume control with daily UF results in improved BP control and, by separating the UF function from HD, adequate weekly standard Kt/V >2 can be achieved with twice weekly HD.