The faster potassium-lowering effect of high dialysate bicarbonate concentrations in chronic haemodialysis patients
The faster potassium-lowering effect of high dialysate bicarbonate concentrations in chronic haemodialysis patients
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DOI：
10.1093/ndt/gfh661
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发表时间：
2005-03-01
影响因子：
6.1
通讯作者：
Bernasconi, AR
中科院分区：
文献类型：
--
作者：
Heguilén, RM;Sclurano, C;Bernasconi, AR
背景资料。高钾血症在晚期肾病患者中很常见。在这项双盲、随机、三序贯、交叉研究中，我们比较了三种透析液浓度([HCO3-])对慢性血液透析(HD)患者常规血液透析(HD)过程中血钾(K+)还原动力学的影响。我们研究了8名稳定的HD患者。透析液[HCO3-]的选择遵循先前指定的治疗方案，所使用的[HCO3-]是低碳酸氢盐(Lb；27 mmoL/L)、标准小苏打(Sb；35 mmoL/L)和高碳酸氢盐(Hb；39 mmol/L)。聚磺酸透析器和自动化机器为每个HD疗程提供300ml/min的血液流速和500ml/min的透析流速。分别于0(基线)、15、30、60和240min从动脉体外循环采血，测定血气和血清电解质。在8名患者中的3名，我们在透析后1h测定了血清K+，并测定了透析对K+的清除。按照同样的程序进行，直到完成研究的三个手臂，每个实验手臂之间间隔1周。血清K+在15、30、60和240min分别降至4.96+/-0.20、4.90+/-0.19、4.68+/-0.13和4.24+/-0.15 mmol/L；SB值分别从5.38+/-0.21降至5.01+/-0.23、4.70+/-0.25、4.3+/-0.15和3.8+/-0.19 mmol/L，Hb值分别从5.45+/-0.25和4.79+/-0.17、4.48+/-0.17、3.86+/-0.16和3.34+/-0.11 mmol/L(P<；在60分钟和240分钟时，高[HCO3-]与标准[HCO3-]和低[HCO3-]相比为0.05)。血清K+的降低与血清[HCO3-]的升高相关(P<；0.05)。三种透析液的钾反弹率分别为3.9+/-10.2%、5.2+/-6.6%和8.9+/-4.9%(P=NS)，总K+清除量分别为116.4+/-2 1.6、73.2+/-12.8和80.9±-15.4(P=NS)。高透析液[HCO3-]与血清K+下降更快有关。我们的结果有力地表明，这种减少是由于K+从细胞外到细胞内液室的增强转移，而不是通过透析将其清除。这一发现可能会对那些患有危及生命的HD前高钾血症的患者产生影响。
Background. Hyperkalaemia is common in patients with advanced renal disease. In this double-blind, randomized, three-sequence, crossover study, we compared the effect of three dialysate bicarbonate concentrations ([HCO3-]) on the kinetics of serum potassium (K+) reduction during a conventional haemodialysis (HD) session in chronic HD patients.Methods. We studied eight stable HD patients. The choice of dialysate [HCO3-] followed a previously assigned treatment protocol and the [HCO3-] used were low bicarbonate (LB; 27 mmol/l), standard bicarbonate (SB; 35mmol/l) and high bicarbonate (HB; 39 mmol/l). Polysulphone dialysers and automated machines provided blood flow rates of 300 ml/min and dialysis flow rates of 500 ml/min for each HD session. Blood samples were drawn at 0 (baseline), 15, 30, 60 and 240 min from the arterial extracorporeal line to assess blood gases and serum electrolytes. In three of the eight patients, we measured serum K+ 1 h post-dialysis as well as K+ removal by the dialysis. The same procedures were followed until the completion of the three arms of the study, with a 1 week interval between each experimental arm.Results. Serum K+ decreased from 5.4 +/- 0.26 (baseline) to 4.96 +/- 0.20, 4.90 +/- 0.19, 4.68 +/- 0.13 and 4.24 +/- 0.15 mmol/l at 15, 30, 60 and 240 min, respectively, with LB; from 5.38 +/- 0.21 to 5.01 +/- 0.23, 4.70 +/- 0.25, 4.3 +/- 0.15 and 3.8 +/- 0.19 mmol/l, respectively, with SB; and from 5.45 +/- 0.25 to 4.79 +/- 0.17, 4.48 +/- 0.17, 3.86 +/- 0.16 and 3.34 +/- 0.11 mmol/l, respectively, with HB (P < 0.05 for high vs standard and low [HCO3-] at 60 and 240 min). The decrease in serum K+ correlated with the rise in serum [HCO3-] in all but LB (P < 0.05). Potassium rebound was 3.9 +/- 10.2%, 5.2 +/- 6.6% and 8.9 +/- 4.9% for LB, SB and HB dialysates, respectively (P = NS), while total K+ removal (mmol/dialysis) was 116.4 +/- 21.6 for LB, 73.2 +/- 12.8 for SB and 80.9 +/- 15.4 for HB (P = NS).Conclusions. High dialysate [HCO3-] was associated with a faster decrease in serum K+. Our results strongly suggest that this reduction was due to the enhanced shifting of K+ from the extracellular to the intracellular fluid compartment rather than its removal by dialysis. This finding could have an impact for those patients with life-threatening pre-HD hyperkalaemia.