Dialysate calcium profiling during hemodialysis: Use and clinical implications
Dialysate calcium profiling during hemodialysis: Use and clinical implications
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DOI：
10.1046/j.1523-1755.2002.00100.x
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发表时间：
2002-01-01
影响因子：
19.6
通讯作者：
Grimani, I
中科院分区：
文献类型：
--
作者：
Kyriazis, J;Glotsos, J;Grimani, I
背景低透析液钙（LdCa）浓度用于预防或治疗血液透析（HD）诱导的高钙血症。但是在某些患者中，透析中低血压使其使用变得复杂。我们的目的是探讨透析钙谱（dCaP）可以改善需要使用LdCa进行透析的HD患者的透析中低血压的可能性。在随机交叉设计中。18例HD患者接受了一次LdCa为1.25 mmol/L的4 h HD治疗（LdCa组）和一次前2 h LdCa为1.25 mmol/L、其余2 h高dCa为1.75 mmol/L的4 h HD治疗（dCaP组）。那之后MdCa组（1.5mmol/L中钙）再次进行4 h HD。在HD前和HD期间的4个60 min间隔，测量血压（BP）、心率（HR）和无创心脏指数（CI）。使用生物电阻抗，获得。还在HD前以及HD治疗开始后120分钟和240分钟测量了离子血清钙（伊卡）。在另一项研究中。8名HD患者用1.25 mmol/L dCa治疗3周，用上述dCaP技术治疗3周，以随机顺序进行。随后用MdCa治疗三周。在每次HD期间记录血压和症状。在LdCa治疗期间，伊卡值保持不变，而平均动脉压（MAP）和CI分别下降16.5 +/- 8.3%和14.2 +/-14.6%。在HD结束时，在dCaP治疗的前半部分。伊卡、MAP和CI分别降低2.2 +/-4.1%、12.6 +/-12.3%和9.6 +/-13.4%。而在相同治疗的后半部分。伊卡。MAP和CI值分别增加10.2 +/-3.3%、7.8 +/- 7.2%和10.8 +/-9.1%。分别从中间HD值。ANOVA显示，时间x处理对伊卡的影响显著。MAP和CI。总外周阻力和HR变化不显著，治疗组间相似。LdCa和MdCa治疗的血液动力学效果相当，仅dCaP治疗可减少透析中事件（P < 0.05）。在LdCa和MdCa组中HD的最后两小时期间观察到的BP下降在dCaP组中被消除，后者通过心输出量增加来实现，这是由于iCa诱导的心肌收缩力增加。因此，dCaP通过个体化使用的dCa浓度并定时在它们之间切换，可以改善透析中BP不稳定性，同时最大限度地降低HD患者发生高钙血症的风险。
Background. Low dialysate calcium (LdCa) concentration is used to prevent or treat hemodialysis (HD)-induced hypercalcemia. but its use has been complicated by intradialytic hypotension in some patients. Our goal was to explore the possibility that dialysis calcium profiling (dCaP) can ameliorate intradialytic hypotension in HD patients who need to have dialysis performed with LdCa.Methods. In a randomized crossover design. eighteen HD patients underwent one four-hour HD session with LdCa of 1.25 mmol/L (LdCa group) and one four-hour HD session with LdCa of 1.25 mmol/L during the first two hours and high dCa of 1.75 mmol/L during the remaining two hours (dCaP group). After that. they underwent another four-hour HD session with medium dCa of 1.5 mmol/L (MdCa group). Before HD and at four 60-minute intervals during the HD sessions, blood pressure (BP), heart rate (HR) and noninvasive measurements of cardiac index (CI). using bioelectrical impedance, were obtained. Ionized serum calcium (iCa) also was measured before HD and at 120 and 240 minutes into the HD session. In a separate study. eight HD patients were treated for three weeks with 1.25 mmol/L dCa and three weeks with the dCaP technique described above, in random order. A three-week treatment with MdCa followed. BP and symptoms were recorded during each HD session.Results. During the LdCa treatment the iCa values remained unchanged, whereas mean arterial pressure (MAP) and CI decreased by 16.5 +/- 8.3% and 14.2 +/- 14.6%. respectively, at the end of HD. During the first half of the dCaP treatment. iCa, MAP and CI decreased by 2.2 +/- 4.1%, 12.6 +/- 12.3%, and 9.6 +/- 13.4%, respectively. whereas during the second half of the same treatment. iCa. MAP and CI values increased by 10.2 +/- 3.3%, 7.8 +/- 7.2% and 10.8 +/- 9.1%. respectively, from the middle HD values. ANOVA showed that the time x treatment effect was significant for iCa. MAP and CI. Total peripheral resistance and HR changes were insignificant and similar among treatments. Hemodynamic effects were comparable between LdCa and MdCa treatments, Intradialytic events were reduced (P < 0.05) only with the dCaP treatment.Conclusions. The drop in BP observed during the last two hours of HD in both the LdCa and MdCa groups was abolished in the dCaP group, The latter was accomplished via an increase in cardiac output, due to an iCa-induced increase in myocardial contractility. Therefore, dCaP, by individualizing the dCa concentrations used and timing the switching between them, may improve intradialytic BP instability and simultaneously minimize the risk for HD patients to develop hypercalcemia.