The hemodynamic effect of calcium ion concentration in the infusate during predilution hemofiltration in chronic renal failure
The hemodynamic effect of calcium ion concentration in the infusate during predilution hemofiltration in chronic renal failure
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DOI：
10.1053/j.ajkd.2005.05.022
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发表时间：
2005-09-01
影响因子：
13.2
通讯作者：
Jensen, JD
中科院分区：
文献类型：
--
作者：
Karamperis, N;Sloth, E;Jensen, JD
背景：目前流行的观点是对流透析技术可以稳定血压。在这方面，置换液中的钙浓度可能很重要。本研究旨在研究置换液中钙离子浓度对前稀释血液滤过（HF）期间血流动力学稳定性的影响。方法：我们对12例稳定的长期血液透析患者进行了随机、交叉、盲法、对照试验。在4.5小时的预稀释HF期间，每例患者被随机分配使用钙离子（伊卡）浓度为2.5 mEq/L（1.25 mmol/L;低钙治疗[L-HF]）或3.5 mEq/L（1.75 mmol/L;高钙治疗[H-HF]）的置换液，体积为1.24 +/- 0.09 L/kg干体重，体温为37摄氏度。每例患者的超滤保持恒定。每隔15分钟测量血压（平均值、收缩压[SBP]和舒张压[DBP]）、脉率、动脉和静脉温度、能量转移和相对血容量。每小时测量一次心输出量、总外周阻力、每搏输出量和伊卡。除伊卡浓度外，2种治疗均匹配。结果：两组治疗期间心输出量和每搏输出量的显著减少程度相同。治疗间比较显示，L-HF组的平均动脉压、SBP、DBP和总外周阻力显著低于H-HF组。结论：伊卡浓度为3.5与2.5。前稀释HF期间输注液中的mEq/L（1.75与1.25 mmol/L）稳定了血压，可能是因为外周阻力更大，而不是通过心脏性能的变化。
Background: It is the prevailing view that convective dialysis techniques stabilize blood pressure. Calcium concentration in the substitution fluid may be important in this respect. The aim of this study is to investigate the influence of calcium ion concentration in the substitution fluid on hemodynamic stability during predilution hemofiltration (HF). Methods: We conducted a randomized, crossover, blinded, controlled trial with 12 stable long-term hemodialysis patients without diabetes. Each patient was randomly assigned to substitution fluid with a calcium ion (iCa) concentration of 2.5 mEq/L (1.25 mmol/L; low-calcium session [L-HF]) or 3.5 mEq/L (1.75 mmol/L; high-calcium session [H-HF]) during 4.5 hours of predilution HF with a volume of 1.24 +/- 0.09 L/kg dry body weight and a temperature of 37 degrees C. Ultrafiltration was kept constant in each patient. Blood pressure (mean, systolic [SBP], and diastolic blood pressure [DBP]), pulse rate, arterial and venous temperature, energy transfer, and relative blood volume were measured at 15-minute intervals. Cardiac output, total peripheral resistance, stroke volume, and iCa were measured hourly. The 2 treatments were matched with the exception of iCa concentration. Results: A significant intratreatment reduction in cardiac output and stroke volume was shown to the same extent for both groups. Intertreatment comparisons showed a significantly lower mean arterial pressure, SBP, DBP, and total peripheral resistance in the L-HF compared with the H-HF group. Conclusion: iCa concentration of 3.5 versus 2.5. mEq/L (1.75 versus 1.25 mmol/L) in the infusate during predilution HF stabilized blood pressure, possibly because of greater peripheral resistance rather than through changes in cardiac performance.