生物电阻抗检测心肾综合征腹膜透析治疗患者容量状态及其在干体质量调整中的作用

目的通过多频生物电阻抗测量方法检测腹膜透析(PD)治疗心肾综合征患者液体负荷情况,评估其在干体质量调整中的作用。方法选择常州市武进人民医院肾病中心诊断为心肾综合征行PD治疗的患者40例为PD组,选取同期在我院体检健康者80例为对照组。测量PD组患者干体质量调整前后及对照组的性别、年龄、体重、血压、生物电阻抗值,包括20、100 kHz频率测量人体总含水量、细胞外液含水量、细胞内液含水量,心脏彩超测量PD组干体质量调整前后心脏各指标。选取PD组干体质量高于对照组双侧95%可信区间上限值的24例患者,逐步下调干体质量,2个月后复测体质量、血压、生物电阻抗值等。结果 (1)PD组生物电阻抗测量值均高于对照组,差异有统计学意义(P0.01)。24例干体质量调整后PD组生物电阻抗测量值高于对照组,差异无统计学意义。(2)24例PD组干体质量调整后生物电阻抗测量值均较调整前下降,差异有统计学意义(P0.05),其中细胞外液含水量生物电阻抗值下降最明显(2.85±0.67)%。24例PD患者干体质量下调后收缩压及舒张压均较下调前下降,其中收缩压改变差异有统计学意义,左心室舒张末容积、左心室收缩末容积较下调前下降,差异有统计学意义。结论多频生物电阻抗测量方法可用于检测腹膜透析治疗心肾综合征患者液体负荷情况,参照正常人范围,用于干体质量的调整。     

糖尿病肾脏疾病血液透析患者与非糖尿病肾脏疾病血液透析患者人体成分测定分析

目的了解糖尿病肾脏疾病(DKD)血液透析患者与非糖尿病肾脏疾病(non-DKD)血液透析患者人体成分的差异,对不同血液透析患者身体水分容量状况及相位角进行评价。方法选取深圳市中医院血液透析患者85例,按其基础肾脏病分为DKD血液透析患者组(31例),non-DKD血液透析患者组(54例)。使用InBody S10人体成分分析仪,测量两组患者细胞外水分比率、相位角等人体成分参数,并进行组间比较。结果 DKD血液透析患者与non-DKD血液透析患者相比,患者的性别、年龄、身高、超滤量均未见显著差异(P0.05)。DKD组平均血压及透析间期体质量、干体质量显著高于non-DKD组,但各节段相位角均低于non-DKD组(P0.05)。此外,DKD组细胞外水分含量以及全身和各节段细胞外水分均高于non-DKD组(P0.05)。结论相比较于non-DKD血液透析患者,DKD血液透析患者身体水分分布异常情况及高血压状况更为严重,同时DKD血液透析患者营养不良风险显著增加。     

多频生物电阻抗法评估血液透析患者干体重

目的 应用多频生物电阻抗评估血液透析患者干体重.方法 选择81例维持性血液透析(Maintenance Hemodialysis,MHD)患者,采用人体成分分析仪,分别于透析前、后测定患者全身液体量(TBW,Total Body Water)、细胞外液(ECW,Extracellular Water)、细胞内液(ICW,Intracellular Water)、ECW与ICW之比E/I、容量超负荷(OH,Overhydration),并分别计算占体重的百分比(TBW％、ECW％和ICW％).结果 患者仅ICW透析前后无明显变化,透析后OH、TBW、TBW％、ECW、ECW％均较透析前明显下降,ICW％较透析前升高;透前TBW、ECW、ICW、TBW％、ECW％、ICW％和OH男性均高于女性,男性ECW/ICW比值低于女性.结论 MHD患者存在体液分布异常,主要表现为ECW％显著增加;血液透析脱水主要是除去多余的ECW,而对ICW无明显影响;多频生物电阻抗法可以对透析患者的容量状况提供客观依据.     

生物电阻抗评估透析病人营养状态与动脉硬化相关性分析

目的:结合生物电阻抗(bioimpedence analysis,BIA)及颈动脉超声对透析病人营养不良状态与动脉硬化相关性进行早期评估。方法:随机选择我院维持性血液透析病人(maintenance hemodialysis,MHD)46例,透析时间均大于3个月,根据颈动脉彩超有无颈动脉粥样斑块形成分为两组,颈动脉斑块形成31例,无颈动脉粥样斑块形成15例,分别测定两组患者的超敏C反应蛋白(hs-CRP)、血清前白蛋白(PA)、白蛋白(Alb)、血红蛋白(Hb)、颈动脉中层厚度(IMT)。生物电阻抗测定体质指数(BMI)、去脂体重(FFM)、体脂百分比(Fat%)、体脂肪量。结果:两组患者的体脂百分比差异存在统计学意义(P<0.01),两组患者的体重指数、去脂体重、白蛋白、前白蛋白、H-CRP、Hb、i PTH、收缩压及透析龄亦差异存在统计学意义(P<0.05)。结论:BIA可以反应病人营养状况,尤其是肌肉含量减少,脂类含量异常,与hs-CRP升高及动脉硬化正相关性,与血清白蛋白、血红蛋白呈负相关,可较好预测营养状态及动脉硬化风险。     

生物电阻抗频谱法分析血液透析患者体液分布异常及其对血压的影响

目的了解血液透析(HD)患者透析前后体液的分布状况及其对血压的影响。方法106例健康志愿者作为正常对照,按性别分为组用生物电阻抗频谱法检测并计算细胞外2,液(ECV)、细胞内液(ICV)占体重的百分比(ECV%、ICV%)和ECV/ICV比值。选择我院透析龄月2以上的稳定HD患者67例,按照透析前后血压状况将患者分为低血压倾向组、正常血压组、普通高血压组和顽固性高血压组,分别于透析前和透析后测量体重、ECV、ICV,并计算ECV%、ICV%和ECV/ICV比值。ECV、ICV采用电生物阻抗分析仪测定。结果HD患者ECV%、ECV/ICV透后较透前下降,而ICV%上升;透前ECV%、ECV/ICV明显高于正常对照,透后接近正常人群水平。顽固性高血压患者(均为男性)透后ECV%仍明显高于正常对照水平[(31.6±1.0)%比(25.3±1.6)%,P<0.01],而低血压倾向患者均为女性在透析前()ECV%即与正常对照水平无明显差异[(21.6±1.5)%比(22.6±1.4)%,P>0.05],透后明显低于正常对照水平[(19.3±1.6)%比(22.6±1.4)%,P<0.01]。结论HD患者水分布与正常人相比存在着明显不同,表现为ECV%增加和ICV%减少,而血液透析通过脱水和水分向细胞内转移部分纠正了这种异常。ECV%反映了HD患者水负荷的情况,并与血压之间存在着密切的关系。     

生物电阻抗评估血液透析患者干体重获益的Meta分析

目的探讨生物电阻抗分析(bioimpedance analysis, BIA)评估血液透析患者干体重的临床价值及长期生存获益。方法对采用生物电阻抗分析法和临床评估法评估血液透析患者容量状态的随机对照试验进行Meta分析。结果与临床评估法相比,生物电阻抗分析法不能降低患者的全因死亡率[RR=0.93,95%CI(0.74,1.16),P=0.52]、全因住院率[RR=0.90,95%CI(0.57,1.42),P=0.65]、心血管事件的发生率[RR=0.71,95%CI(0.47,1.06),P=0.09]及透析中低血压的发生率[RR=0.96,95%CI(0.91,1.02),P=0.22];但有助于降低血液透析患者的透析前收缩压[MD=-3.99,95%CI(-6.25,-1.73),P=0.0005]、左心室质量指数[SMD=-0.24,95%CI(-0.42,-0.05),P=0.01]及脉搏波传导速度[MD=-2.03,95%CI(-3.36,-0.69),P=0.003]。结论与临床评估法相比,BIA评估血液透析患者的干体重不能降低其全因死亡率、全因住院率、心血管事件及透析中低血压的发生率,但能改善透析前收缩压、左心室质量指数和动脉僵硬度,从而改善患者的生活质量。     

小腿电阻抗比值评价透析患者容量对改善高血压的作用

目的 用小腿电阻抗比值（calf-RBI）评价血液透析（HD）患者容量状况,观察容量负荷过重者在calf-RBI指导下降低干体质量对血压的作用。 方法 应用多频生物电阻抗分析仪测量小腿电阻抗,以calf-RBI=200 kHz电阻抗/5 kHz电阻抗为容量负荷指标。根据健康对照组各年龄层的calf-RBI确定正常参考范围。降低calf-RBI增高者干体质量,观察calf-RBI、血压和降压药用量等的变化。 结果 calf-RBI在健康对照组和HD组均呈正态分布,与性别、BMI无相关,仅与年龄呈正相关（健康对照组r = 0.269,P ＜ 0.01;HD组r = 0.486,P ＜ 0.01）。117例HD患者中,42例（35.9%）透析后calf-RBI高于正常参考范围,其未控制的高血压的发病率为59.5%,明显高于calf-RBI正常者的33.3%和calf-RBI降低者的16.7%（P ＜ 0.01）。calf-RBI增高者降低干体质量后,calf-RBI明显降低至正常参考范围（P ＜ 0.01）,未控制的高血压的发生率从74.1%下降至33.3%（P ＜ 0.01）,降压药用量也较前减少（P ＜ 0.05）。 结论 小腿电阻抗比值作为评价容量负荷的一种指标,符合生理学原理,与临床表现有良好相关性,有助于识别和纠正HD患者慢性容量过负荷,改善容量相关高血压。     

生物电阻抗分析法指导血液透析超滤联合 α-酮酸配伍低蛋白饮食对患者残余肾功能的影响

目的通过生物电阻抗分析法指导血液透析超滤,观察结合α-酮酸配伍低蛋白饮食对新进入血液透析患者残余肾功能(residual renal function,RRF)的影响。方法选取2016年1月至2017年10月在江阴市人民医院血液净化中心新进入血液透析的终末期肾病患者160例,随机分为A组(α-酮酸配伍低蛋白饮食)、B组(生物电阻抗分析)、C组(α-酮酸配伍低蛋白饮食联合生物电阻抗分析)、D组(对照组),动态随访各组治疗前后6个月的RRF变化。A组患者采用α-酮酸配伍低蛋白饮食,并根据患者心胸比、透析间期体质量增长量及透析间期低血压、口干、肌肉抽搐等不良反应等传统方式指导透析超滤量;B组为生物电阻抗分析指导透析超滤,饮食为正常蛋白饮食;C组患者采用α-酮酸配伍低蛋白饮食,并通过生物电阻抗分析指导透析超滤,D组为正常蛋白饮食,与A组相同的传统方式指导透析超滤量。比较4组随访前后的24 h尿量、RRF、平均动脉压、血透超滤量及透析不良事件的发生率。结果 4组24 h尿量、RRF、平均动脉压、平均透析超滤量随访前后自身相比较,差异均有统计学意义(P0.01),4组白蛋白随访前后比较,差异无统计学意义(P0.05)。随访6个月后,4组RRF及24 h尿量均呈下降趋势,差异有统计学意义(F_(组间)=5.530,F_(组内)=352.146,P0.05和F_(组间)=765 426.35,F_(组内)=59 645.256,P0.001);其中C组RRF(6.0±0.6) mL/min在4组中保护程度最好,有显著性差异(P0.05),且下降速度较其余3组更平缓,而A组(4.6±0.5) mL/min、B组(4.8±0.6) mL/min、C组(6.0±0.6) mL/min均较D组(3.7±0.6) mL/min保护程度更好,差异显著(P0.05)。A组24 h尿量(922.4±85.1)mL、B组24 h尿量(901.9±97.9)mL、C组24 h尿量(1 187.1±211.4)mL均高于D组24 h尿量(653.2±74.2)mL,差异有统计学意义(P0.05);4组透析期间平均超滤量之间比较,差异有统计学意义(F_(组间)=15.341,F_(组内)=32.625,P0.01),其中A组(0.85±0.21)L、C组(0.60±0.25)L低于B组(0.92±0.17)L、D组(1.31±0.52)L,差异有统计学意义(P0.05),B、D 2组之间比较,差异有显著性(P0.05)。随访期间各组发生透析不良事件比较,A组发生6起,B组3起,C组1起,D组8起,差异有统计学意义(χ~2=3.771,P=0.013)。随访后各组收缩压、舒张压、白蛋白比较均无统计学意义(P0.05)。结论在生物电阻抗分析法指导血液透析超滤的基础上,透析患者采用α-酮酸配伍低蛋白饮食,能维持患者营养状况,避免低蛋白血症,同时可精确评估透析超滤量,有利于延缓RRF下降速度,保护RRF,同时能显著减少透析期间不良事件的发生率。     

InbodyS10多频生物电阻抗仪评估持续性血液透析患者体液分布情况的初步研究

目的 初步分析在维持性血液透析患者中应用Inbody S10评估体液分布情况并制定干体重的效果.方法 选择北京东直门医院和北京东方医院血液净化中心维持性血液透析患者,在透析前、后应用Inbody S10多频生物电阻抗仪进行测量并分别计算干体重,同步记录患者透析前、后的体重及设定的超滤量,采用统计学方法进行分析.结果 最终纳入103例维持性血液透析患者,透析前细胞内水含量为(20.6±4.4)L,透析后细胞内水为(19.5±4.4)L,透析前、后的差值为(1.3±0.7)L.透析前细胞外水含量为(13.7±2.7)L,透析后细胞外水为(12.5±2.6)L,透析前、后的差值为(1.3±0.5)L.依据透析前测量结果计算的干体重为(63.16±14.44) kg,依据透析后测量结果计算的干体重为(61.24±14.30) kg,两者之间的相差值为(1.92± 1.14)kg.结论 血液透析对维持性血液透析患者的细胞内水和细胞外水都具有清除作用,透析前、后制定的干体重存在较大差值,干体重制定方法还需进一步探讨.     

腹膜透析患者高血压的产生与容量超负荷的关系

目的探讨腹膜透析高血压患者血压与容量超负荷和水盐的关系。方法随机选择我院门诊连续3个月随诊的165例腹膜透析患者,分为血压持续升高组(PH,33),血压波动组(IH,58),血压正常组(PN,74),而IH组义分为血压正常(IH—N)和血压升高两组(IH-H)。用生物阻抗分析仪评估患者的容量指标。结果3组在年龄、性别、透析时间的构成比上均无显著性差异。PH组的体重比IH组和PN组高(P<0.05)。生物阻抗分析显示,PH组和IH-H组的细胞外液(ECW)、总体液量(TBW),高于IH-N组和PN组(P<0.01)。总液体清除量在PH组和IH—H组均高于IH-N和PN组(P<0.05)。与PH组和IH—H比较,总钠清除量和血钠浓度在IH—N和PN组均低(P< 0.05)。3组的总尿素清除指数Kt/V均无显著性差异。结论腹膜透析患者发生高血压时伴明显容量超负荷,而且在容量超负荷时钠和液体的清除均明显增高,提示饮食中水盐的摄入增加是患者出现容量超负荷的主要原因。     

Diagnosis and prognosis of pulmonary hypertension in patients on hemodialysis using spiral CT scanning

Objective To assess the value of multislice spiral computed tomography (MSCT) in diagnosing pulmonary hypertension. Methods One hundred and forty-two patients on hemodialysis were divided into the group with pulmonary artery hypertension and the group without pulmonary artery hypertension. The diagnosis of pulmonary artery hypertension (pulmonary artery systolic pressure, PASP＞35 mmHg) was according to the guideline from the American Society of Echocardiography. All patients were received the check of MSCT and the diameters of the main pulmonary artery, ascending aorta and descending aorta were recorded. PASP and left ventricular ejection fraction were assessed by echocardiography. High sensitivity C-reactive protein and tumor necrosis factor were measured by automatic analyzer and enzyme linked immunosorbent assay. Results There were significant differences between the two groups in systolic blood pressure, hemoglobin, serum albumin, high sensitivity C-reactive protein and TNF-α (P＜0.05); There were significant differences between the two groups in diameters of the maim pulmonary artery, ratio of the diameter of the main pulmonary artery to the diameter of ascending aorta and ratio of the diameter of the main pulmonary artery to the diameter of descending aorta (P＜0.05). In different heart function groups, there were significant differences in diameters of the main pulmonary artery, ratio of the diameter of the main pulmonary artery to the diameter of ascending aorta, and ratio of the diameter of the main pulmonary artery to the diameter of descending aorta, and left ventricular ejection fraction (P＜0.05). Ratio of the diameter of the maim pulmonary artery to the diameter of ascending aorta was positively related to PASP (r=48.77, P＜0.01), and left ventricular ejection fraction was negatively related to PASP (r=-0.40, P＜0.01). In multivariate linear regression, TNF-α, ratio of the diameter of the maim pulmonary artery to the diameter of ascending aorta and ejection fraction were independent factors of PASP (P＜0.01). Conclusions MSCT measurements play an important role in diagnosis of pulmonary hypertension and in evaluation of clinical prognosis in patients on hemodialysis.     

Related factors of pre-dialysis blood pressure variability in under-age patients undergoing maintenance hemodialysis

Objective To explore the blood pressure variability (BPV) in pediatric patients undergoing maintenance hemodialysis (MHD) and to assess the factors associated with pre-dialysis BPV(pre-HD BPV). Methods The pediatric patients who undergone regular dialysis for more than twelve months from Oct 2005 to Oct 2011 in hemo dialysis center of Guizhou Provincial People's Hospital were divided into high pre-HD BPV group and low pre-HD BPV group. Baseline characteristics, biochemical indexes and cardiac function parameters measured by echocardiography were collected in both groups and multiple linear regression analysis was performed. Results Pediatric patients in high pre-HD BPV group demonstrated significantly higher inter-dialytic weight growth rate (IDWG), pre-dialysis systolic blood pressure and average amount of dehydration than those in low pre-HD BPV group (P＜0.05), while significantly lower hemoglobin and albumin levels than those in low pre-HD BPV group (P＜0.05). Comparison among laboratory indicators, serum phosphorus and parathyroid hormone demonstrated significant difference between groups (P＜0.05). For all pediatric patients, pre-HD BPV was positively correlated with IDWG (β=0.165), pre-dialysis systolic blood pressure (β=0.259), and iPTH (β=0.187), while negatively correlated with hemoglobin level (β=-0.199). Conclusions Increasing IDWG, higher pre-dialysis systolic blood pressure, anemia and secondary hyperparathyroidism influence BPV in pediatric patients on MHD.     

Relationship of rest metabolic rate with anthropometry in maintenance hemodialysis patients

Objective To explore the feasibility of bioelectrical impedance analysis in assessing resting energy metabolism (REM) and the association of REM with anthropometry in hemodialysis patients. Methods Adult hemodialysis patients from 11 hemodialysis facilities in Guizhou Province were enrolled in this study. Bioelectrical impedance analysis was used to measure the rest metabolic rate (RMR) and body composition of 765 patients undergoing regular dialysis. A standard method was used to measure their height, weight, upper arm circumference, triceps skinfold thickness, left calf circumference and grip strength. The upper arm muscle circumference was also calculated. The level of RMR and body composition in hemodialysis patients were compared by gender grouping. The patients were then divided into four groups according to the RMR quartile. Spearman correlation analysis and multiple linear regression analysis were derived to analyze the relationship between RMR and anthropometry. Results The level of RMR in male patients was significantly higher than that in female patients [1591(1444, 1764) Rcal/d and 1226(1104, 1354) Rcal/d, P＜0.001]. Compared with the first quartile of RMR group, upper arm circumference, upper arm muscle circumference, left calf circumference and grip strength in the fourth quartile group were increased significantly (all P＜0.05). Multiple linear regression analysis showed that height (β=0.572), left calf circumference (β=0.273), upper arm muscle circumference (β=0.092) and suffering from protein energy wasting (PEW, β=-0.184) were independent influential factors of RMR (all P＜0.05). Conclusions RMR levels in patients with maintenance hemodialysis are associated with left calf circumference and upper arm muscle circumference, which may become a new index to evaluate energy consumption and malnutrition in MHD patients.     

每日透析滤过治疗尿毒症难治性高血压的疗效观察

目的 观察费森尤斯4008ARrTplus治疗模式下延时每日透析滤过治疗尿毒症并发难治性高血压患者的临床疗效.方法 回顾性分析15例尿毒症并发难治性高血压患者经延时每日透析滤过治疗后血压控制情况及治疗前、后血甲状旁腺激素水平、体重改变.结果 15例患者经过延时每日透析滤过治疗后收缩压、舒张压、平均动脉压、血甲状旁腺激素...     

Survival of analysis of older patients with external iliac vein tunneled cuffed catheters on maintenance hemodialysis

Objective To investigate the survival of older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis. Methods A total of 70 older patients with external iliac vein tunneled cuffed catheters on maintenace hemodialysis were included in this study, there were 94 patients with internal jugular vein tunneled cuffed catheters as control group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were documented. Results There were lower survival rate and catheter survival in the external iliac vein group compared with internal jugular vein group（χ2=13.714, P＜0.01;χ2=13.093, P＜0.01）. Compared with internal jugular vein group, there was lower rate of catheter infection in external iliac vein group(χ2=9.416, P＜0.01); In addition, there were higher rate of cardiovascular disease(CVD) events and catheter dysfunction among patients in external iliac vein group (χ2=7.492, P＜0.01;χ2=5.912, P＜0.05). Furthermore, the incidence of catheter dysfunction and cardiovascular disease events were the independent risk factors of mortality for older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis by Cox regression model. Conclusions Patients with iliac vein tunneled cuffed catheters have a shorter survival time. Those with catheter dysfunction or cardiovascular disease events are in higher risk of mortality．     

Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients

BACKGROUND: It remains uncertain whether the hemodynamic parameters are important determinants of left ventricular mass (LVM) in normotensive chronic hemodialysis (NTHD) patients, as has been found in their hypertensive counterparts. METHODS: Forty NTHD patients (mean age, 53.7 +/- 14.4 years; male/female, 18/22) without the requirement of antihypertensive drugs for at least six months were studied. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46 normotensive subjects with normal renal function (NTNR). The influence of anthropometrics, cardiovascular structure and function, and volume status on LVM (by two-dimensional echocardiography) was analyzed by steps of multiple linear regression. RESULTS: As compared with the NTNR and NTHD group, the HTHD group had obvious pressure and volume/flow overload, and greater LV wall thickness, chamber size and mass. In contrast, NTHD subjects had similar blood pressure, large artery function, LV chamber size and stroke volume as the NTNR subjects. However, the NTHD patients still had greater wall thickness and LVM, along with greater cardiac output, lower total peripheral resistance and lower end-systolic meridional stress to volume ratio (ESSV) than the NTNR group. LVM in the NTHD group was significantly positively related to averaged systolic blood pressure (SBPavg), body surface area, extracellular fluid (ECF), carotid intima-media thickness (IMT), aortic pulse wave velocity (PWV), and negatively related to ESSV and Kt/V. The independent significant noncardiac structural determinants of LVM in NTHD subjects were ESSV, SBPavg, PWV and SV (model r2 = 0.617, P < 0.001). CONCLUSIONS: The NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical LV dysfunction.     

维持性血液透析患者透析间期血压节律影响因素的分析

目的 观察维持性血液透析患者透析间期血压节律可能存在的异常并讨论其影响因素。 方法 选择44例维持性血液透析患者，均于透析间期(透析前1 d)进行24 h动态血压监测，根据动态血压监测结果将患者分为3组：非高血压组、高血压控制组及高血压未控制组。监测或评估3组患者的血红蛋白(Hb)、血肌酐(Scr)、Kt/V、血清钙(Ca)、磷(P)、全段甲状旁腺素(iPTH)、透析间期体质量增加(IDWG)、Morisky依从性评分等。对相应的指标进行统计分析，筛选出影响血压节律的因素。 结果 （1）动态血压相关参数包括夜间血压下降率、收缩压和舒张压的夜间下降率、动态动脉硬化指数(AASI)、杓形血压比例在3组之间的差异无统计学意义。高血压未控制组的24 h平均脉压比其他两组高[（80.06±13.41）比（53.00±7.73）、（57.85±21.97） mm Hg，均P < 0.01]。（2）3组患者血压曲线均呈现“两峰一谷”的表现，高血压未控制组夜间血压下降不明显。（3）夜间收缩压下降率与血iPTH呈负相关(r = －0.349， P = 0.024)。（4）44例患者中的全部10例杓型血压节律者的AASI与夜间舒张压下降率呈负相关(r = －0.748，P = 0.013)。 结论 维持性血液透析患者夜间血压下降与甲状旁腺素及血管硬化程度有关。     

Ultrafiltration volume is associated with changes in blood pressure in chronically hemodialyzed patients

INTRODUCTION: Volume overload is a main factor in development of hypertension in hemodialysis patients. In order to demonstrate impact of ultrafiltration volume on blood pressure during 15-months period in a group of patients undergoing chronic hemodialysis therapy, we conducted this study. We hypothesized that ultrafiltration volume different affects the pre/postdialysis systolic pressure, diastolic pressure, mean arterial pressure (MAP), and pulse pressure (PP) values. SUBJECTS AND METHODS: Study subjects were 23 anuric chronically hemodialyzed patients. The overall study time was 15 months, and 136 single hemodialysis treatments were analyzed. RESULTS: Ultrafiltration was negatively correlated with predialysis systolic blood pressure (r = -0.169, p = 0.025), postdialysis systolic blood pressure (r = -0.292, p < 0.001), postdialysis MAP (r = -0.186, p = 0.015), predialysis PP (r = -0.290, p < 0.001), and postdialysis PP (r = -0.370, p < 0.001). Ultrafiltration/dry body mass (UF/W) ratio was negatively correlated with predialysis PP (r = -0.222, p = 0.005), postdialysis PP (r = -0.340, p < 0.001), and postdialysis systolic blood pressure (r = -0.243, p = 0.002). We found significant difference in postdialysis PP between dialyses with UF/W ratio < or = 0.05 an dialyses with UF/W ratio > 0.05 (63.49 +/- 20.76 vs. 56.27 +/- 16.33 mmHg, p = 0.033). CONCLUSION: The ultrafiltration volume strongly affects postdialysis PP values. Evaluation of elevated blood pressure treatment in patients undergoing chronic hemodialysis therapy must be considered in respect of postdialysis PP values, not just depending on pre/postdialysis systolic and diastolic pressur or MAP values.     

Dry weight evaluation in hemodialysis patients

Objective To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume（RBV） and other judgments. Methods One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure: normal blood pressure group (A group, n=43）, hypotension group (B group, n=35) and hypertension group (C group, n=35). The level of hemoglobin, serum albumin, dialysis adequacy were determined. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, ultrafiltration volume, relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients. Each of the patients was continuously monitored of the indicators above for 10-12 times. At the observing period, the inferior vena cava diameter (IVCD), brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured. Then according to the monitoring results, appropriate clinical interventions were given under on-line blood volume monitoring guidance. Results (1)The shape of RBV curve in group A showed double-exponential curve early, then down to the final linear decling ended during hemodialysis. (2)The RBV curve in group B was stable in the former two hours, then rapidly linear declined. RBV changes were significantly higher in group B than group A (P＜0.05), but when changes in RBV were plotted against ultrafiltration volume, there was no significant difference in the two groups. The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P＜0.05, coefficient of variation=0.28). (3)The RBV curve in group C slowly linear declined. At the end of dialysis, RBV changes were significantly lower in group C than group A (P＜0.05). (4)The IVCD values in three groups of patients before dialysis were greater than normal, significantly decreased after the dialysis (P＜0.05), but that in group B and group C were still greater than that in group A (P＜0.05). The BNP values were significantly greater in three groups before and after dialysis (P＜0.05), but after dialysis, the values decreased significantly than that before dialysis (P＜0.05). (5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis, the patients of group B controlled weight gain, and even cut dry weight, the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P＜0.05); When the patients of group C cut dry weight, increased ultrafiltration, the RBV change increased, the mean arterial pressure decreased significantly than before (P＜0.05). Conclusions (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes, which provides important information for forecasting the symptomatic hypotension in hemodialysis. (2)IVCD and CTR have certain significance to the adjustment of dry weight, but the BNP has guiding significance to volume change. (3)On-line monitoring of RBV can effectively guide the adjustment of dry weight, reduction of symptomatic hypotension occruence, and controlling of refractory hypertension in hemodialysis.