What are the causes of the ill effects of chronic hemodialysis? The fallacy of low interdialytic weight gain and low ultrafiltration rate: lower is not always better.
What are the causes of the ill effects of chronic hemodialysis? The fallacy of low interdialytic weight gain and low ultrafiltration rate: lower is not always better.
复制标题
慢性血液透析不良反应的原因是什么？
DOI：
10.1111/sdi.12151
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发表时间：
2014
影响因子：
1.6
通讯作者：
Agarwal,Rajiv
中科院分区：
文献类型：
--
作者：
Sinha,ArjunD;Agarwal,Rajiv
Despite 50 years of experience, outcomes for patients on chronic hemodialysis (HD) remain poor. Annual mortality rate remains in excess of 20% and morbidity remains high with an average of 1.9 hospitalizations per HD patient per year (1). These outcomes persist despite Medicare spending over $23 billion in 2010 for chronic HD alone, fully 4.5% of the entire Medicare budget (1). The leading causes of mortality in this population are cardiovascular, yet traditional risk factors don’t explain the high cardiovascular risk in this population. There are numerous hypothesized causes for this excess cardiovascular risk; one modifiable but often overlooked factor is volume overload. Not only does volume overload play a major role in causing hypertension in this population, but it also contributes to cardiac remodeling manifest as chamber enlargement and left ventricular hypertrophy. Additionally, two recent cohort studies have shown volume overload measured by objective methods to be independently associated with subsequent all-cause mortality (2; 3). The more direct sequelae of volume overload also remain common, with a 13.7% risk per patient-year of requiring hospital based acute dialysis for volume overload not of primary cardiac etiology (4).Managing volume overload requires vigilant minimization of volume gain coupled with adequate volume removal. Volume removal is achieved by ultrafiltration on dialysis, guided by the dry weight method. The latter is an iterative technique and remains the gold-standard because of lack of validated objective measures of volume status. The dry-weight method allows for the extracellular fluid volume that is optimal for a given individual. On the other hand, volume gain is minimized by providers limiting the prescribed dialysate sodium concentration and by patients reducing their dietary sodium intake, both of which are associated with lower interdialytic weight gain (IDWG). Thus lower IDWG is a desirable goal for HD patients. However, is lower IDWG always preferable?
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影响因子：
2.2
作者：
VOGT, RF;PHILLIPS, DL;SPIERTO, FW
通讯作者：
SPIERTO, FW
影响因子：
2.2
作者：
T. V. Updyke;G. Nicolson
通讯作者：
T. V. Updyke;G. Nicolson
不同的封闭剂会导致转移至硝酸纤维素膜的蛋白质的免疫学检测发生变化。
影响因子：
2.2
作者：
Spinola,SM;Cannon,JG
通讯作者：
Cannon,JG
DOI：
10.1016/0735-0651(84)90049-9
发表时间：
1984-01-01
期刊：
Gene Analysis Techniques
影响因子：
--
作者：
Johnson, D. A.;Gautsch, J. W.;Elder, J. H.
通讯作者：
Elder, J. H.
影响因子：
2.2
作者：
HOFFMAN, WL;JUMP, AA
通讯作者：
JUMP, AA