腹膜透析患者的总外周阻力对血压与容量关系的影响

该文研究腹膜透析(PD)患者中高血压与正常血压患者容量状态发生重叠的血流动力学机制。方法:选取51例 PD 患者,采用生物电阻抗方法评估患者的细胞外液(ECW)、细胞内液(ICW)、总体水(TBW)水平,并通过身高标化后得出 NECW。根据不同性别组NECW 的平均水平定义为正常容量状态组(NV 组,     

腹膜透析患者容量控制对血压的影响

目的探讨限制水钠摄入对腹膜透析患者容量负荷及血压的影响。方法对45例腹膜透析患者,实行限制水钠摄入治疗2个月,测量患者治疗前后的体重、体液容量及血压等相关资料。结果治疗后,33例患者体重减轻(1.9±1.4)kg,细胞外液(ECW)减少(1.20±0.81)L,收缩压(SBP)降低(9.2±14.3)mmHg,差异均有显著性(P<0.01);患者体力、睡眠、饮食等自我感觉改善。另12例患者体重增加(1.2±1.2)kg,ECW增加(0.55±1.09)L,收缩压升高(2.8±10.6)mmHg。治疗前患者收缩压与nECW可能有直线相关关系(r前=0.285,P=0.058);治疗后则显著相关(r后=0.359,P=0.017),还受抗高血压药物治疗的影响(r后=0.334,P=0.027);各因素变化量之间存在直线相关关系。结论腹膜透析患者中,体液容量与血压间存在正相关关系。严格限制患者水钠摄入可以有效控制容量过度负荷,从而控制血压。     

腹膜透析患者的总外周阻力对血压与容量关系的影响

该文研究腹膜透析（PD）患者中高血压与正常血压患者容量状态发生重叠的血流动力学机制。方法：选取51例PD患者，采用生物电阻抗方法评估患者的细胞外液（ECW）、细胞内液（ICW）、总体水（TBW）水平，并通过身高标化后得出NECW。根据不同性别组NECW的平均水平定义为正常容量状态组（NV组，NECW≤平均水平）及高容量状态组（HV组，NECW〉平均水平）。     

终末期肾病血液透析患者的血压季节性变化

心血管系统疾病 (脑卒中和缺血性心脏病 )是终末期肾病血液透析患者死亡的重要原因 ,高血压又是造成心血管疾病的主要危险因素。终末期肾病患者可以通过透析纠正细胞外液过量而使血压维持正常。但是由于影响血压的因素众多 ,大多数透析病人仍需要服用抗高血压药物。为此 ,作者研究了血液透析病人的血压季节性变化情况。方法和结果　在 4年期间 ,作者对 5 3例进行血液透析的终末期肾病患者在平均 3 1个月中每周进行 3次血液透析治疗 ,每次透析前测血压 1次 ,同时每月测定 1次透析量和蛋白代谢分解率 ,并分析了每月的血压、脉搏和体重平均值与…     

腹膜透析和血液透析患者与正常人群体液状况的比较

目的　比较并分析持续性非卧床腹膜透析 (CAPD)及血液透析 (HD)患者的体液状况。方法　通过无创性方法 (Xitron 42 0 0生物电阻抗分析仪 )分别测定 45例CAPD患者、44例HD患者和 46例正常人的细胞外液 (ECW )、细胞内液 (ICW )和总体液量 (TBW ) ,用标准体重 (身高 -10 5 )进行标准化后比较。结果　CAPD组标准化细胞外液 (nECW )比HD透析前、HD透析后及对照组均高。HD透析前组nECW比对照组高 ,但透析后组与其比较无显著性差异。HD透析前与透析后组的标准化细胞内液 (nICW )没有显著变化 ,但是与CAPD组及对照组比较均有显著性差异 ;而CAPD组与对照组间比较 ,无显著性差异。在体液分布 (ECW /TBW )上 ,各组间比较均有显著性差异。CAPD组与HD组患者间干体重比较无显著性差异 ;CAPD组患者体重与干体重之差为 ( 2 .6± 2 .4)kg ,与HD透析前组比较差异无显著性 ,而与HD透析后组 [( 0 .3± 2 .5 )kg ]比较 ,有显著性差异。结论　慢性腹膜透析患者普遍存在比血液透析患者更严重的容量超负荷。而腹透患者体液过多的原因可能与其过多水分摄入有关     

血液透析患者血容量监测的意义

目的了解血容量监测对评价透析患者干体重和防治透析患者难治性高血压、透析中低血压中的作用.万法38例规律性血液透析患者,其中男8例,女30例,患者平均年龄(54.2±11.5)岁,其中2例为糖尿病肾病.根据患者临床表现分为病情稳定组(A)、低血压倾向组(B)和难治性高血压组(C).对所有患者进行血红蛋白、血清白蛋白、超声心动图和透析充分性检查,观察透析前后血压、心率及体重,透析中监测超滤量、血压、心率、临床症状和血容量变化.结果A组27例,一次透析血容量下降(△BV)5.1%～26.1%之间,其中△BV＜15%者和△BV＞15%者临床指标无明显差异;B组9例,△△BV在12.5%～22.6%之间,和A组患者相比,年龄偏大(P=0.03)和脱水量过多(P=0.006),两组之间的其他因素无显著性差异.对其中3例透析中发生低血压患者在血容量监测的指导下上调干体重,透析结束时血容量下降程度明显好转(21.03%±1.99%vs16.06%±2.03%,P=0.04),未再发生低血压.C组2例,△BV＜5%,在连续血容量监测下,下调干体重后,血压得到有效控制.结论在透析过程中,患者所能耐受的血容量下降程度存在着明显的个体差异.根据患者临床表现结合血容量监测有助于确定合适的超滤量、调整干体重、防治透析过程中低血压和指导治疗透析患者难治性高血压.     

高通量透析对维持性血液透析患者高血压的影响

目的探讨高通量透析对维持性血液透析患者高血压的影响。方法选取2014-06~2016-06收治的行维持性血液透析的患者112例进行研究,根据入院顺序随机分为观察组和对照组,每组56例。对照组行低通量透析,观察组行高通量透析,两组均透析4周。比较两组患者治疗前后的血压变化以及不良反应的发生情况。结果两组患者治疗后收缩压(SBP)和舒张压(DBP)水平均明显下降,组内前后差异有统计学意义(P0.05),且观察组显著低于对照组(P0.01)。观察组的不良反应发生率为5.36%,明显低于对照组的16.07%(P0.05)。结论采用高通量透析对维持性血液透析患者可以有效降低和控制血压水平,减少不良反应,适合临床推广。     

在线血容量监测防治血液透析中低血压的价值

目的 探讨在线容量监测在防治透析中症状性低血压的作用,寻找预测低血压发生的量化指标.方法 入选71例维持性血液透析患者,分为血压稳定组(A组)、症状性低血压组(B组),分为观察期和干预期两个阶段研究,并比较两组患者的低血压发生情况.结果 两组患者透析中的RBV曲线初始呈双指数逐渐下降,直至HD结束.经BVM指导下的临床干预后,B组患者透析结束时RBV变化幅度明显降低,低血压事件发生率显著减少.结论 在线血容量监测能减少血透中症状性低血压的发生.     

慢性肾衰血液透析病人的高血压

众所周知,高血压是慢性肾衰患者的常见并发症,也是促使肾功能进行性恶化的重要因素。终末期肾衰病人约80%以上合并高血压,血液净化疗法可在数周及数月内使多数尿毒症患者的血压降为正常.10～20%的透析患者虽经有效透析仍存在高血压。长期高血压所致的心脑血管疾病就成为维持性血透病人最重要的危险因素和主要伤亡原因。因此研究慢性透析患者高血压的发生机理和治疗措施对透析病人的长期存活是十分重要的. 终末期肾衰(ESRD)高血压发生机理一、容量机制:即容量依赖性高血压.许多肾衰病人,高血压与细胞外液容量和总体可交换钠(NaE)增高有关,血压与容量及总体可交换钠成正相关.体钠成为主要的血压调节因子.但钠潴留与容量扩张引起高血压的机理尚不十分清楚。二、肾素血管紧张素和水钠平衡之间相互作用的异常。尿毒症病人,即使摄入中等量的钠盐(100     

腹膜透析患者水平衡状态的评价及对策

维持水平衡是透析治疗的基本目的之一。然而，水平衡紊乱在腹膜透析（PD）患者中很常见，这是导致患者高血压及心功能不全的最重要的原因。同时，水超滤衰竭也是患者PD技术性失败的一个重要因素。我们的临床观察发现，约1／3稳定的维持性PD患者处于高血容量状态，同时，半数以上的患者需服用降压药物控制血压。国外的研究对比了PD和血液透析（HD）患者细胞外容量（ECV）情况，     

Volume status and blood pressure in continuous ambulatory peritoneal dialysis patients

The pathophysiology of hypertension in dialysis patients is largely attributed to positive sodium balance and volume expansion. Whereas the relationship between fluid status and blood pressure control in hemodialysis patients is well established, this relationship is not well studied in peritoneal dialysis patients. METHODS: 100 stable CAPD patients who had been dialyzed for more than 3 months, as well as 60 healthy controls, were studied cross-sectionally. CAPD patients were divided into three groups according to their blood pressure level: group 1 (normotension), group 2 (controlled hypertension with antihypertensive medication (AHM)) and group 3 (uncontrolled hypertension with AHM). Extracellular water (ECW) and intracellular water (ICW) were measured using bioimpedance spectroscopy in all subjects. Dialysis adequacy and transport test was conducted in each patient. RESULTS: Height normalized ICW (nICW) was much lower, and ECW/ICW was higher in both male and female dialysis patients as compared to healthy controls. nECW was also significantly higher in group 3 when compared to group 1. The dose of AHM was similar in group 2 and group 3. In female CAPD patients, there were no differences in urinary volume (UV) and the total fluid removal among the three patient groups. However, in male CAPD patients, UV and total fluid removal were significantly higher in group 3 than in group 1. Renal and total removal of sodium was also significantly higher in group 3 male patients than group 1. CONCLUSIONS: Peritoneal dialysis patients with uncontrolled hypertension are more volume overloaded and their blood pressure may be difficult to control by AHM alone. These findings indicate that volume control preferably by dietary salt and fluid restriction should be intensified in hypertensive CAPD patients.     

Reliability of Blood Pressure Parameters for Dry Weight Estimation in Hemodialysis Patients

Chronic volume overload resulting from interdialytic weight gain and inadequate fluid removal plays a significant role in poorly controlled high blood pressure. Although bioimpedance has been introduced as an accurate method for assessing hydration status, the instrument is not available in general hemodialysis (HEMO) centers. This study was conducted to explore the correlation between hydration status measured by bioimpedance and blood pressure parameters in chronic HEMO patients. Multifrequency bioimpedance analysis was used to determine pre‐ and post‐dialysis hydration status in 32 stable HEMO patients. Extracellular water/total body water (ECW/TBW) determined by sum of segments from bioimpedance analysis was used as an index of hydration status. The mean age was 57.9 ± 16.4 years. The mean dry weight and body mass index were 57.7 ± 14.5 kg and 22.3 ± 4.7 kg/m², respectively. Pre‐dialysis ECW/TBW was significantly correlated with only pulse pressure (r = 0.5, P = 0.003) whereas post‐dialysis ECW/TBW had significant correlations with pulse pressure, systolic blood pressure, and diastolic blood pressure (r = 0.6, P = 0.001, r = 0.4, P = 0.04, r = ?0.4, and P = 0.02, respectively). After dialysis, the mean values of ECW/TBW, systolic blood pressure, mean arterial pressure, and pulse pressure were significantly decreased. ECW/TBW was used to classify the patients into normohydration (≤0.4) and overhydration (>0.4) groups. Systolic blood pressure, mean arterial pressure, and pulse pressure significantly reduced after dialysis in the normohydration group but did not significantly change in the overhydration group. Pre‐dialysis pulse pressure, post‐dialysis pulse pressure, and post‐dialysis systolic blood pressure in the overhydration group were significantly higher than normohydration group. Due to the simplicity and cost, blood pressure parameters, especially pulse pressure, might be a simple reference for clinicians to determine hydration status in HEMO patients.     

Impact of intradialytic blood pressure changes on cardiovascular outcomes is independent of the volume status of maintenance hemodialysis patients

Intradialytic systolic blood pressure (SBP) changes are related to the volume status; however, whether SBP change impacts on adverse outcomes depends on the volume status remains uncertain. We retrospectively investigated the relationship among intradialytic changes in SBP, cardiovascular outcomes, and volume status in maintenance hemodialysis patients. We determined SBP changes (ΔSBP) as postdialysis SBP minus predialysis SBP and volume status as the ratio of extracellular water to total body water (ECW/TBW) using bioelectrical impedance analysis. There were 82 (60.3%) with ΔSBP ?20 to 10 mm Hg, 21 (15.4%) with ΔSBP ≤ ?20 mm Hg, and 33 (24.3%) with ΔSBP ≥ 10 mm Hg, and they were followed up for a median of 34 months. Cardiovascular events more frequently occurred in the patients with ΔSBP ≤ ?20 mm Hg and ≥ 10 mm Hg (hazard ratio: 2.3 and 3.0; P = .062 and .006); these associations persisted even after adjusting for postdialysis ECW/TBW (P = .056 and .028). Moreover, ΔSBP ≥ 10 mm Hg was associated with increased cardiovascular mortalities independent of postdialysis ECW/TBW (P = .043). There was an independent association of volume status between considerable SBP decrease or increase during hemodialysis and adverse cardiovascular outcomes. Besides appropriate volume control, other factors related to BP changes during hemodialysis must be investigated.     

血液净化技术对尿毒症患者血浆瘦素、神经肽Y的影响

目的　研究血液净化技术对血浆瘦素、神经肽 Y(NPY)的影响 ,探讨改善尿毒症营养不良的有效措施。方法　本文尿毒症患者 6 9例 ,根据所采用的血液净化技术分为 3组 :低通量纤维素膜透析组 (A组 ) 32例 ,低通量血仿膜 F6透析组 (B组 ) 2 1例 ,F6 0高通量血滤器透析滤过并血液透析组 (C组 ) 16例。另选择 18例健康查体者作为对照组。利用放射免疫法测定患者透析前、后及对照组空腹静脉血的瘦素及 NPY水平。结果　三组瘦素与 NPY水平透析前明显高于对照组 (P<0 .0 1) ;透析后 A、B组瘦素、NPY水平未降低 ,C组瘦素水平明显降低 (P<0 .0 5 ) ,但 NPY无显著变化。结论　尿毒症患者存在高瘦素及 NPY血症 ,二者无相关性 ,都不能通过单纯血液透析清除。利用高通量血滤器进行血液滤过有助于增加瘦素的清除率 ,改善患者营养状态。     

伴阻塞性睡眠呼吸暂停低通气综合征高血压患者的血压控制研究

目的探讨伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的高血压患者,同时服用降压药和接受持续气道正压通气(CPAP)是否能有效控制血压。方法选取2014年1月至2015年6月南京医科大学第一附属医院睡眠中心就诊的伴有OSAHS高血压患者180例,根据服用降压药物后血压是否被有效控制,分为控制组(n=87)和未控制组(n=93),两组在服用降压药同时接受CPAP 6个月,比较服用不同降压药方案和CPAP治疗前后血压是否得到有效控制的关系。结果所有患者共使用13种不同的降压药方案进行治疗。控制组与未控制组患者降压药方案差异无统计学意义(P0.05),多因素logistic回归分析表明降压药方案不是影响伴OSAHS高血压患者血压控制的独立预测因子(OR=1.897,P=0.094)。使用CPAP后控制组、非控制组夜间收缩压(SBP)和舒张压(DBP)均下降,差异有统计学意义(P0.01)。结论伴OSAHS高血压病患者的降压治疗方案与血压控制无明显相关性,而CPAP治疗可使降压药有效组和无效组患者的夜间血压都降低。     

Hypertension in patients on chronic hemodialysis: the role of the renin-angiotensin system

The effects of volume-loading and removal on mean blood pressure were evaluated in patients with high blood pressure and on chronic hemodialysis. Simultaneous measurements of plasma renin activity, plasma angiotensin II and plasma norepinephrine were made. The patients were divided into two groups according to their levels of plasma renin activity. Group 1 (n = 10) had a basal plasma renin activity below 2.5 ng/ml/hr while the level in group 2 (n = 5) exceeded 2.5 ng/ml/hr. The mean blood pressure of the two groups was 105 +/- 5 mmHg and 107 +/- 4 mmHg, respectively. On the day of hemodialysis, saline loading (0.5 ml/kg/min for 20 min) was followed by routine hemodialysis. The mean blood pressure rose to 113 +/- 6 mmHg in group 1. However, the patients in group 2 did not respond to volume loading and hemodialysis. The plasma renin activity, plasma angiotensin II and plasma norepinephrine were not changed by volume loading in both group 1 and 2. Volume removal by hemodialysis caused a reduction in mean blood pressure in group 2 without alteration of vasoactive hormones. In group 1, the mean blood pressure was not reduced by hemodialysis, accompanied by increases in plasma renin activity, plasma angiotensin II, and plasma norepinephrine. In the high renin group, elevated circulating angiotensin II maintained a high blood pressure and in the low renin group, the renin-angiotensin system influenced the prevention of fall in blood pressure after hemodialysis. These results suggest that the renin-angiotensin system plays an important role in the regulation of blood pressure in relation to volume status regardless of whether the plasma renin activity is high or low.     

维持性血液透析患者的血压与透析充分性及相关因素分析

目的观察维持性血液透析(MHD)患者血压与透析充分性及其它相关因素间的关系。方法 56例MHD连续12次记录透析前后血压、体重、超滤量(FV),分别计算收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)的均值,第0、1、2、3个月透析前后测定血液生化值、甲状旁腺激素(PTH)、血红蛋白(Hb)、红细胞压积(Hct),计算尿素清除指数(Kt/V)、尿素下降率(URR)。结果透析充分组(Kt/V≥1.2、URR≥0.65)MHD患者血压明显低于透析不充分组(Kt/V<1.2、URR<0.65)差异有统计学意义(P<0.05);Hct≥0.22组与Hct<0.22组比较MAP差异有统计学意义(P<0.05);Logistic回归分析显示透析间期体重增加量、体重增加率、透析不充分及血清PTH水平与透析前收缩压密切相关(OR=1.98~3.50,P<0.05)。结论充分透析、减少容量负荷是控制MHD患者高血压的关键,透析不充分、透析间期体重增长过多、高血清甲状旁腺激素水平与透析前收缩压升高有密切关系。     

Seasonal variation in blood pressure of patients on continuous ambulatory peritoneal dialysis

BACKGROUND: A seasonal variation in blood pressure (BP) has been observed in hemodialysis and renal transplant patients. However, this phenomenon in continuous ambulatory peritoneal dialysis (CAPD) patients, whose hemodynamics are different from hemodialysis patients, has not been reported before. In addition, the contribution of extracellular water (ECW) in the seasonal variation in BP is not clear. METHODS: All stable CAPD patients (n = 122) dialyzed in a single center from January 1, 2003 to December 12, 2004 were studied. Systolic blood pressure (SBP), diastolic blood pressure (DBP), weight and ECW (by bioimpedance analysis) were measured in every patient. Climatic data were obtained from the Beijing Weather Bureau. These data were pooled together and grouped according to the calendar month. RESULTS: In general, an apparent seasonal variation in BP was observed in CAPD patients. BP began to decrease from spring and reached the lowest level in summer, then increased from autumn and reached its peak in winter. The seasonal variation in BP in male patients was similar to that in female patients, but in comparison to non-diabetic patients there was no apparent seasonal variation in the BP of diabetic patients. SBP and DBP negatively correlated with the average atmospheric temperature (r = -0.768, p < 0.001 and r = -0.764, p < 0.001, respectively). BP also negatively correlated with rainfall and humidity, but this correlation disappeared when temperature was controlled in partial correlation analysis. Weight and ECW fluctuated throughout the year but showed no seasonal variation. CONCLUSION: On the whole there was an apparent seasonal variation in blood pressure in CAPD patients. As opposed to non-diabetic patients, there was no apparent seasonal variation in BP in diabetic patients. The seasonal variation in BP was influenced more by temperature than rainfall and humidity, and the change in ECW was not seasonal, suggesting that other mechanisms such as total peripheral resistance might play a more important role in this phenomenon.     

Reference values for multifrequency bioimpedance analysis in dialysis patients

BACKGROUND: The role of multifrequency bioimpedance(MF-BIA) in the assessment of fluid status in dialysis patients is still not fully elucidated. Especially, the predictive value of reference values for extracellular water (ECW) has not yet been addressed. Aim of the present study was to validate cut-off values for MF-BIA in the diagnosis of hypervolemia in dialysis patients, using strict clinical criteria and echocardiography as reference techniques. METHODS: 90 patients [42 on hemodialysis; 48 on peritoneal dialysis] were divided into the following groups: clinically normovolemic (mean 24- or 48-hour systolic blood pressure below 133 mm Hg without use of antihypertensive agents; n = 12), 'hypervolemic' (mean systolic blood pressure above 133 mm Hg with 2 or more antihypertensive agents; n = 34) or undetermined (n = 44). The 80th percentile for normalized ECW in the clinically normovolemic patients was used as reference value. 20 healthy age-matched controls were included for comparison. RESULTS: The 80th percentiles for ECW:body weight (BW) and ECW:height in 'normovolemic' subjects were, respectively, 0.245 liters/kg and 10.96 liters/m in males, and 0.232 liters/kg and 9.13 liters/m in females. ECW:BW and ECW:height were above these values in, respectively, 26 (sensitivity 76%) and 29 (sensitivity 86%) of the 34 'hypervolemic' patients. In the undetermined group, left ventricular end-diastolic diameter was significantly different between patients with normalized ECW below and above these cut-off values (49.0 +/- 5.1 vs. 52.4 +/- 5.7 mm; p < 0.05). Use of the ECW:TBW ratio resulted yielded low sensitivity (45%). ECW:height was lower in the 'normovolemic' dialysis patients compared to healthy controls (9.7 +/- 1.3 l/m versus 12.2 +/- 1.9 l/m). CONCLUSION: In our study population, ECW by MF-BIA, normalized for height was able to predict hypervolemia, based on strict clinical criteria, with a sensitivity of 86% and a specificity of 80%. The normalization procedure for ECW may influence the classification of hydration status. Strictly normotensive dialysis patients had lower normalized ECW than healthy control subjects.     

Hemodialysis patients with less extracellular water overload and smaller cardiac atrial chamber sizes are at greater risk of a fall in blood pressure during dialysis

Intradialytic hypotension is the most common complication of hemodialysis (HD) treatments. Excessive ultrafiltration results in reduced cardiac preload. We aimed to determine whether a fall in systolic blood pressure during HD was greater in patients starting HD with (a) less overhydration measured by extracellular water (ECW) and (b) lower cardiac preload by cardiac magnetic resonance imaging (MRI). Pre‐HD measurements of ECW and total body water (TBW) were performed using multifrequency bioimpedance (MFBIA). Cardiac chamber sizes and functions were determined by MRI. Twenty‐six patients, 18 males (69.2%), 11 (42.3%) with diabetes, mean age 63.9 ± 15.9 years were studied. Systolic blood pressure (SBP) fell in 15 (57.7%) patients, and either did not change or increased in 9. There was no difference in demographics between groups. Patients with a fall in SBP had lower pre‐HD ECW/TBW (0.400 ± 0.018 vs 0.418 ± 0.021), indexed right ventricular end‐diastolic volume (81.2 ± 37.6 vs 100.8 ± 33.7 mL/m²), and indexed left atrial size (13.7 ± 3.9 vs 18.3 ± 5.0 mL/m²), all P < .05, respectively. There were univariate correlations between the change in SBP and pre‐HD ECW/TBW for the trunk (r = .50, P = .009) and indexed left atrial volume (r = .54, P = .005). A fall in blood pressure occurred more commonly in patients starting HD with lower overhydration as measured by bioimpedance, and those with smaller cardiac chamber sizes. Patients with the lowest ECW/TBW and smallest cardiac chamber sizes had the greatest falls in SBP. This study reinforces the importance of determining physiological target weights and avoiding inappropriately low target weights for HD patients.