Predilution hemodiafiltration displays no hemodynamic advantage over low-flux hemodialysis under matched conditions
Predilution hemodiafiltration displays no hemodynamic advantage over low-flux hemodialysis under matched conditions
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DOI：
10.1111/j.1523-1755.2005.00242.x
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发表时间：
2005-04-01
影响因子：
19.6
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。人们普遍认为对流透析技术可以稳定血压。本研究的目的是在严格控制的条件下比较高剂量预稀释血液透析滤过 (HDF) 和低通量血液透析期间的血流动力学。方法。在一项随机交叉、盲法对照试验中对 12 名稳定的血液透析患者进行了调查。患者被分配到 1 次预稀释 HDF（置换液 1.20 +/- 0.10 L/kg 体重）和 41/2 小时进行 1 次血液透析。为了消除混杂因素，透析剂量、超滤量和动脉温度相匹配。在透析开始时，患者的核心温度被调节透析液温度的自动反馈系统“锁定”；因此，患者的体温在整个治疗过程中保持稳定。置换液/透析液中的钙离子浓度为1.25mmol/L。通过超声速度稀释法每小时测量心输出量。结果。两种治疗方法中的平均血压、心输出量、每搏输出量、心脏做功和相对血容量均显着降低。两组的总外周阻力均显着增加。血液透析和 HDF 的超滤量、心肺再循环、Kt/V 和总能量转移相似。两次治疗期间脉搏率均无显着变化。血液透析和 HDF 之间没有显着差异。结论。预稀释 HDF 和低通量血液透析的血流动力学在匹配条件下表现出相似的特征。无法证明对流溶质去除相对于扩散去除的急性循环益处。
Background. It is the prevailing view that convective dialysis techniques stabilize blood pressure. The aim of this study was to compare the intrasession hemodynamics during high-dose predilution hemodiafiltration (HDF) and low-flux hemodialsis, under strict controlled conditions.Methods. Twelve stable hemodialysis patients were investigated in a randomized crossover blinded controlled trial. The patients were allocated to one session of predilution HDF (substitution fluid 1.20 +/- 0.10 L/kg body weight) and one session of hemodialysis at 41/2 hours. To eliminate confounding factors, dialysis dose, ultrafiltration volume and arterial temperature were matched. At the start of the dialysis the patients' core temperature was "locked" by an automatic feedback system regulating the dialysate temperature; thereby, patients' temperature was kept stable throughout the whole treatment. The calcium-ion concentration in the substitution/dialysis fluid was 1.25 mmol/L. Cardiac output was measured hourly by the ultrasound velocity dilution method.Results. Mean blood pressure, cardiac output, stroke volume, cardiac work, and relative blood volume was significantly reduced in both treatments. Total peripheral resistance increased significantly in both groups. Ultrafiltration volume, cardiopulmonary recirculation, Kt/V, and total energy transfer were similar for hemodialysis and HDF. The pulse rate showed no significant change throughout both sessions. No significant differences were revealed between hemodialysis and HDF.Conclusion. The hemodynamics of predilution HDF and low-flux hemodialysis displayed a similar profile during matched conditions. An acute circulatory benefit of convective solute removal over diffusive could not be demonstrated.