Adjustment of Dry Weight in Hemodialysis Patients using Intradialytic Continuous Multifrequency Bioimpedance of the Calf
Adjustment of Dry Weight in Hemodialysis Patients using Intradialytic Continuous Multifrequency Bioimpedance of the Calf
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使用小腿透析中连续多频生物阻抗调整血液透析患者的干重
DOI：
10.1177/039139880402700205
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
N. Levin
中科院分区：
文献类型：
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作者：
F. Zhu;M. Kuhlmann;S. Sarkar;C. Kaitwatcharachai;R. Khilnani;E. Leonard;R. Greenwood;N. Levin
目前关于干重（DW）处方的概念主要基于临床症状，因为在透析过程中很难评估细胞外液容量（ECV）。通过连续区域小牛多频生物阻抗谱（BIS），可以记录分析内ECV的变化为细胞外电阻[Re]的变化。我们假设，当ECV降至正常水平并达到个体干重时，小牛Re的相对变化（' 0 ' Re / ' t ' Re [Re-0/Re-t]）将变得非常小。方法对15例血液透析（HD）患者进行反复记录。第一次测量是在现行临床干重（CDW）上进行的。每次治疗后体重逐渐减少0.2-0.3 kg，随后进行测量。这一过程在随后的几次治疗中反复进行，直到观察到Re-0/Re-t的变化< 1%。处理结束时的体重被定义为“达到干重（ADW）”。使用Matlab程序（曲线拟合工具箱）拟合每条Re-0/Re-t曲线，以获得Re-0/Re-t斜率开始变平后20分钟的确切重量（从BIS， DW-BIS估计的“干”重量）。结果平均ADW（80.5±34.1 kg）和平均DW-BIS（80.6±34.1）均显著低于CDW(81.4±32.0 kg, p < 0.001)，但ADW和DW-BIS之间无显著差异。然而，从CDW到ADW的平均体重减轻（0.80±0.15 kg）显著高于CDW到DW-BIS的平均体重减轻（0.66±0.14 kg, p < 0.001，配对t检验）。当达到ADW时，透析前收缩压（SBP）低于CDW(139.3±32.5 mmHg, vs. 129.4±33 mmHg, p < 0.05)， hd后收缩压无差异。临床水合不足症状的发生率在CDW组（15%）和DW-BIS组（15%）相似，但在ADW组（46%）更高。结论：分析连续小牛BIS可以评估小牛细胞外阻力的变化，作为细胞外液量变化的指标。在透析期间记录连续的Re-0/Re-t斜率似乎是预测血液透析患者干重的一种有前途的新工具。
Background Current concepts of dry weight (DW) prescription are largely based on clinical symptoms because of the difficulty in assessing extracellular fluid volume (ECV) during dialysis. Intradialytic changes in ECV can be recorded as changes in extracellular resistance [Re] by continuous regional calf multifrequency bioimpedance spectroscopy (BIS). We hypothesized that relative changes in calf Re (Re at time ‘0’ over Re at time ‘t’ [Re-0/Re-t]) will become very small when ECV is reduced towards normal and individual dry weight is reached. Method Intradialytic continuous calf BIS was recorded repeatedly in 15 hemodialysis (HD) patients. The first measurement was performed at the prevailing clinical dry weight (CDW). Next measurements were made after post-HD body weight was gradually decreased by 0.2–0.3 kg per treatment. This procedure was iterated over several subsequent treatments until a treatment was observed where changes in Re-0/Re-t were < 1%. The weight at the end of this treatment was defined as “achieved dry weight (ADW)”. Each Re-0/Re-t curve was fitted using a Matlab program (curve fitting toolbox) to obtain the exact weight at 20 min after beginning of the flattening of the Re-0/Re-t slope (‘dry’ weight estimated from BIS, DW-BIS). Results Both mean ADW (80.5 ± 34.1 kg) and mean DW-BIS (80.6 ± 34.1) were significantly lower than CDW (81.4 ± 32.0 kg, p < 0.001), but there was no difference between ADW and DW-BIS. However, the average weight reduction from CDW to ADW (0.80 ± 0.15 kg) was significantly higher than from CDW to DW-BIS (0.66 ± 0.14 kg, p < 0.001, paired t-test). When ADW was achieved, pre-dialysis systolic blood pressure (SBP) was lower than at CDW (139.3 ± 32.5 mmHg, vs. 129.4 ± 33 mmHg, p < 0.05), post-HD SBP did not differ. The incidence of clinical symptoms of underhydration was similar at CDW (15 %) and DW-BIS (15 %), but higher at ADW (46 %). Conclusion Intradialytic continuous calf BIS allows the assessment of changes in extracellular calf resistance as an indicator of changes in extracellular fluid volume. Recording of a continuous Re-0/Re-t slope during dialysis appears to be a promising new tool for the prediction of dry weight in hemodialysis patients.