腹膜透析在小儿先天性心脏病术后的应用

目的:探讨腹膜透析在婴幼儿先天性心脏病(先心病)术后的应用。方法:13例行先心病手术的患儿术后因出现急性肾损伤(acute kidney injury,AKI)或低心排出量综合症(低心排)行腹膜透析。①总结手术时间、体外循环时间、主动脉阻断时间及腹膜透析持续时间。②比较透析前后SCr、乳酸(Lac)、中心静脉压(CVP)、尿量、血管活性药物评分及左心室射血分数。③根据死亡与否分为2组:死亡组;非死亡组,比较各组术后循环及肾功能转归情况。④根据急性肾损伤程度分组,比较SCr下降情况。结果:本组患儿手术时间90~420min,平均(206±90)min。8例患儿进行了体外循环,运转时间90~196min,平均(129±40)min,其中有7例患儿阻断升主动脉,并于主动脉根部灌入停跳液使心脏停跳,时间为52~126min,平均(85±24)min。腹透持续时间为72~360h,平均(138±80)h。腹膜透析后第7天Lac,CVP,正性肌力药平分(IS)降低,与透析前比较,P0.05,差异有统计学意义。肾损伤程度越重,SCr下降越不明显。透析后第3天和第5天AKI-3级患儿的SCr水平高于AKI-1级和AKI-2级患儿水平,P0.05,差异有统计学意义。结论:先心病手术后发生AKI或低心排时行腹膜透析可以排出体内多余水分及代谢产物,促进心功能恢复。肾损伤程度越重,SCr下降越不明显且恢复时间越长。     

新疆地区107例低体质量婴儿先天性心脏病的外科治疗

目的:探讨新疆地区体质量5 kg以下少数民族婴儿,先天性心脏病(先心病)的外科治疗方法及围术期处理。方法:2006年7月至2011年12月,本院手术治疗5 kg以下先心病患儿107例,年龄11 d至13个月,体质量2.6～5 kg。病种包括:动脉导管未闭(PDA)4例,室间隔缺损(VSD)和(或)房间隔缺损(ASD)54例,其中部分伴动脉导管未闭(PDA)和(或)肺动脉高压(PH),肺动脉瓣狭窄(PS)1例,法洛三联症3例,法洛四联症(TOF)9例,完全性心内膜垫缺损(ECD)9例,右心室双出口(DORV)9例,完全性大血管转位(TGA)8例(室间隔完整4例,室间隔缺损4例),完全性肺静脉异位引流(TAPVC)3例,主动脉弓缩窄(COA)并室间隔缺损、房间隔缺损3例,肺动脉闭锁(PA)2例,三尖瓣闭锁(TA)1例,房室连接不一致1例。本组中I期根治手术96例,减状手术11例(肺动脉环缩术6例,中心分流术4例,右心室流出道疏通术1例);体外循环下手术93例,其中深低温停循环3例。结果:本组术后早期死亡6例(5.6%),死于低心排出量综合征(低心排)1例,多脏器衰竭2例,呼吸衰竭2例,凝血功能障碍1例。术后主要并发症:低心排9例,多脏器损害5例,肾衰竭3例,肺部感染28例,心律失常3例,切口感染3例,心包积液2例,残余分流1例及乳糜胸1例。随访2个月～5年,81例无中期死亡,再手术3例。结论:严格评估低体质量先心病患儿手术适应证和时机,加强围手术期处理,是提高治疗效果的关键。     

右外侧小切口行法洛四联症根治术346例临床分析

目的:总结右外侧小切口剖胸行法洛四联症根治的经验及技术关键。方法:1997年1月至2013年10月,本手术组经右外侧小切口根治法洛四联症346例。其中男性159例,女性187例。年龄4个月~5岁;体质量6~15kg,平均体质量(9.7±2.4)kg。合并卵圆孔未闭43例、房间隔缺损22例、动脉导管未闭10例、永存左上腔静脉10例、主动脉瓣下隔膜7例、二尖瓣关闭不全1例。跨环补片205例,右心室流出道补片141例。结果:术中体外循环时间(90±24)min;主动脉阻断时间(64±17)min,术后机械通气时间4~165 h,监护室停留时间(3.2±1.7)d,术后当日胸腔引流量(138±91)mL,平均带胸管(2.5±0.9)d。术后并发症36例(1.04%):低心排出量综合征(低心排)17例(死亡5例),严重肺部感染2例(死亡1例),灌注肺5例(死亡1例),右肺损伤7例,膈神经损伤4例,室间隔缺损残余分流2例,乳糜胸2例。死亡共计7例,病死率2.02%。结论:经右外侧小切口行法洛四联症根治安全可靠。     

电视胸腔镜室间隔缺损修补术67例报告

目的 :报告电视胸腔镜下室间隔缺损修补术 6 7例的结果。方法 :2 0 0 0年 6月至 2 0 0 2年 5月 ,行右侧胸壁打孔电视胸腔镜下室间隔缺损修补手术 6 7例 ,其中男性 36例 ,女性 31例 ,年龄 3～ 39岁 ,体重 13～ 6 8kg。室缺直接缝合 6 2例 ,涤纶补片修补 5例 ,同时行三尖瓣成形 5例。结果 :术中扩大切口 2例 ,室缺残余漏 1例 ,二次开胸止血 1例 ,手术时间 3 0～ 5 6h ,平均 3 1h。体外循环时间 6 2～ 15 2min ,平均 98min ;升主动脉阻闭时间 16～ 5 2min ,平均 2 8min。术后患者恢复顺利 ,治疗效果满意。结论 :电视胸腔镜下室间隔缺损修补术是可行的 ,安全的。     

婴儿期体外循环术后床边紧急再开胸手术11例

目的总结婴儿期体外循环术后床边紧急再开胸手术经验及教训,以减少心脏术后2次开胸的发生率。方法回顾性分析婴儿心内直视手术365例,其中行监护病房床边紧急再次开胸手术11例,发生率3.12%。室间隔缺损并重度肺动脉高压2例,法洛四联症2例,完全性肺静脉异位引流(心上型)3例,完全性房室管畸形1例,重度肺动脉狭窄1例,右心室双出口1例,大动脉转位1例。体外循环时间53～240min,主动脉阻断时间30～130min。两次手术间隔3～60h,平均16h。结果再开胸的原因:活动性出血2例;广泛性渗血5例;心脏压塞2例;心包填塞1例;心肌收缩无力1例。床边紧急再开胸手术后,死亡1例,继发脑损害1例,败血症1例。结论采取缩短体外循环时间;术中有效的止血及必要地扩大纵隔容积;术后引流管的负压吸引;术后早期充分镇静条件下的气道护理等措施,可减少2次开胸的发生率。遇到:①怀疑心脏填塞;②出血不止,引流量多;③心搏骤停等严重情况或经药物治疗无效时,应紧急开胸手术抢救,任何犹豫与延误,将失去对患者的抢救机会。虽然是紧急手术,仍必须注意无菌操作。     

手术治疗低体重先心病婴幼儿的体外循环管理体会(附102例报告)

随着心外科手术技术和技巧的提高 ,低体重婴幼儿先天性心脏病 (先心病 )的手术数量逐渐增加 [1] ,同时 ,与体外循环 (CPB)相关的水潴留问题亦随之突出。降低术后水潴留的发生 ,是低体重先心病婴幼儿术中 CPB管理的重点 ,也是保证手术成功的关键因素之一。现将近 5年来我院对低体重先心病婴幼儿术中 CPB的管理体会介绍如下。1　资料与方法1 998年 1月至 2 0 0 3年 3月 ,收治低体重 (≤1 0 kg)先心病婴幼儿 1 0 2例 ,年龄 2～ 2 4个月 ;体重4.2～ 1 0 kg。简单病种 85例 ,以室间隔缺损为主 ;复杂病种 1 7例 ,其中法洛四联症 1 4例 ,完全性…     

右外侧小切口剖胸矫治小儿先天性心脏病1972例

目的:总结右外侧小切口剖胸矫治先天性心脏病(先心病)的经验,探讨右外侧切口在先心病的应用与推广。方法 :2002年1月至2011年10月,本手术组经右外侧剖胸小切口完成1 972例小儿先天性心脏畸形矫治。其中男性1 143例,女性829例。年龄平均38.7个月(3～489个月),体质量平均11.6 kg(4.8～69 kg)。主要病种:室间隔缺损、房间隔缺损及法洛四联症等。结果 :术后并发症81例(4.1%):低心排出量综合征(低心排)26例(死亡3例)、严重肺部感染22例(死亡2例)、二次开胸止血8例(死亡1例)、多脏器功能衰竭4例(死亡1例)、一过性脑功能障碍5例、术后残余分流6例(经原切口再次手术1例)、右膈神经麻痹5例(1例膈肌折叠)、术后房室传导阻滞4例(1例置永久起搏器)、乳糜胸2例。随访3～108个月,3例法洛四联症存在残余梗阻26～50 mmHg(1 mmHg=0.133 kPa)观察中,1例二尖瓣成型术后大量反流行二尖瓣置换。结论:先心病可以在右外侧剖胸小切口下完成,该入路安全可靠、创伤小、暴露好并恢复快。     

老年患者心脏瓣膜置换术中体外循环管理体会

目的总结老年心脏瓣膜病患者心脏瓣膜置换术体外循环管理经验。方法选取2009年1月~2014年12月我院收治的老年心脏瓣膜疾病患者295例作为研究对象,回顾性分析老年人患者心脏瓣膜置换术体外循环管理。结果体外循环时间44~318 min,平均(120.8±50.9)min;主动脉阻断时间24~192 min,平均(87.3±36.9)min。术后呼吸机辅助通气时间2~352 h,平均(27.6±42.5)h;ICU逗留时间1~40天,平均(2.8±4.8)天;住院时间11~64天,平均(25.5±9.1)天。本组围术期共死亡10例(3.4%),术中死亡2例:左心室破裂1例,另1例为巨大左心室患者,术毕反复室颤、并发低心排出量综合征而死亡;术后死亡8例,死亡原因为:恶性心律失常2例,多器官衰竭5例,低心排出量综合征2例。放弃治疗5例(低心排出量综合征1例,肾功能衰竭3例,多器官功能衰竭1例)。结论尽管老年心脏瓣膜病患者手术风险较高,加强体外循环管理可为心脏手术的成功奠定良好的基础。     

腹膜透析在小儿先天性心脏病术后低心排的应用

目的观察腹膜透析对小儿先天性心脏病术后的低心排治疗效果。方法回顾性分析该院12例先天性心脏病术后低心排早期治疗使用腹膜透析效果。腹透液选择百特公司2．5％低钙腹膜透析液。单次腹膜透析量15～20ml／kg,透析时进液时间20～30rain,保留30min,排出20min,视患儿血压情况而定。待出现尿液后,逐步延长腹透间隔时间。乳酸高者保留腹透时间较长（40—60min）。根据临床表现和血清肌酐、乳酸调整透析频率。监测血糖和电解质,动静脉血气分析,及时补充胶体。记录患儿腹膜透析开始时间、持续时间和尿量恢复时问。结果尿量恢复时间为5～22h。应用呼吸机时间为70～128h,滞留监护室时间为5—18d。并发症为导管堵塞3例,低血糖3例,高血糖1例,低钾血症2例。无腹膜炎及肠穿孔病例发生。2例死亡病例均为法洛四联症。死亡原因为严重低心排,多器官功能障碍。结论早期应用腹膜透析可以减轻心肺肾负担,维持内环境的稳定,降低病死率。     

389例先天性心脏病右外侧小切口剖胸心内直视手术

目的:总结经右胸外侧小切口体外循环下行先天性心脏病心内直视手术经验。方法:1996年11月至2011年12月,我科室应用右胸小切口完成各类先天性心脏病(先心病)的心内直视手术389例。年龄1.5～57岁,平均13.5岁。体质量7.6～68 kg,平均24.5 kg。手术切口后缘自右腋中线第3肋间处,向前下斜行达锁骨中线第6肋间处做8～12 cm弧形切口,第4肋间入胸。手术方式:房间隔缺损修补157例,室间隔缺损修补150例,部分房室隔缺损矫治8例;右心室流出道疏通术24例;法洛三联症矫治32例,法洛四联症矫治5例以及其他畸形矫治13例。随机选择同期常规手术(胸正中切口)患者100例作为对照。结果:研究组切口长度、手术时间及术后引流量都显著低于对照组;研究组术后呼吸机辅助时间明显低于对照组;术后监护时间各组间差异无统计学意义。研究组手术死亡4例(1.03%),2例死于术后脑栓塞,另外2例死于低心排出量综合征(低心排)。结论:右胸小切口手术入路,可安全有效地行常见先心病的矫治。该技术创伤小、恢复快、美观,并提高了患者的生活质量,值得进一步推广应用。     

长期维持性透析患者行腹部外科手术的临床分析

目的探讨尿毒症透析患者行腹部外科手术的安全性和围手术期处理方法。方法回顾性分析第二军医大学附属长海医院。肾内科2003年6月至2007年6月接受腹部外科手术的34例透析患者的围手术期情况。结果所有患者均在术前术后微调透析方案后接受手术，术后3例合并冠心病患者死亡，其余患者出院，随访60d均存活且完全恢复规律透析。结论在围手术期全面评估、综合施治及严密监控下，长期维持性透析患者可以接受腹部外科手术并获得良好的长期预后。     

Risk evaluation and midterm outcome of cardiac surgery in patients on dialysis

The medical charts of 54 patients on maintenance dialysis who underwent cardiovascular surgery (37 elective and 17 urgent/emergency) from 1994 to 2004 were retrospectively analyzed. Thirty patients had coronary artery bypass grafting (17 elective and 13 urgent/emergency), 18 had valve replacement (16 elective and 2 urgent/emergency), and 6 underwent aortic surgery (4 elective and 2 urgent/emergency). The overall early mortality rate was 11.1%, comprising 2 patients (5.4%) who had elective operations and 4 (23.5%) who had urgent or emergency operations ( p = 0.049). The overall 5-year survival rate was 48.4%. The 5-year survival rate was 67.2% for elective surgery and 10.5% for urgent/emergency surgery ( p = 0.0001). The midterm clinical results after elective cardiovascular surgery were acceptable, whereas the results after urgent/emergency surgery were poor. For elective surgery, sufficient and detailed preoperative examinations might have contributed to the better operative outcome. Early diagnosis and consultation to avoid urgent/emergency operations in dialysis patients is recommended.     

2 Renal Anemia Treatment In Peritoneal Dialysis Patients: A Multicenter Slovenian Study

Abdominal surgery is considered problematic if performed on dialysis patients who are on peritoneal dialysis. There is a common clinical practice to switch these patients to hemodialysis postoperatively for a period of time. Our attempt was to keep these patients on peritoneal dialysis after abdominal surgery, using a modified protocol of low volume exchanges. During the last two years, three of our patients on peritoneal dialysis underwent abdominal surgery. In one patient, laparoscopic cholecystectomy was performed, and abdominal hernia repair was performed in the other two. The day after the operation, we started with low volume (500 mL) exchanges with solutions with 1.36% glucose. During the daytime we prescribed four exchanges, and during the nighttime we put patients on automatic peritoneal dialysis (APD), also with low volume exchanges. After 5 days, the volume of exchanges was gradually increased and after 3 weeks all three patients were on their standard preoperative dialysis regime. Periodically, we controlled the adequacy of dialysis with Kt/V, which was not changed during these procedures. There were no complications postoperatively. We conclude that this modified protocol of peritoneal dialysis was useful and safe in all our patients and there was no need to switch patients to hemodialysis. Further clinical experience with a large number of patients might confirm the usefulness of low volume exchange protocol.     

Calcification and degeneration following mitral valve reconstruction in patients requiring chronic dialysis

BACKGROUND AND AIM OF THE STUDY: Abnormal calcium homeostasis in patients with end-stage renal failure results in dystrophic calcification; this limits the use of heterograft tissue valve prostheses in patients on chronic dialysis. Mitral valve reconstruction offers advantages over mitral replacement in many patients without renal failure, and offers theoretical advantages in patients requiring dialysis. This study was performed to determine the outcome of mitral valve reconstruction in patients with renal failure requiring chronic dialysis. METHODS: Ten patients with end-stage renal failure and on chronic dialysis who underwent mitral valve repair were identified retrospectively and followed for clinical and echocardiographic outcome. All patients had good results immediately following surgical valve mitral repair, with no more than mild mitral regurgitation and low transmitral gradients on intraoperative transesophageal echocardiography. RESULTS: Clinical and echocardiographic follow up was available for eight patients at an average of 2.3 +/- 1.4 years after surgery. Despite there being no significant valve calcification at the time of surgery, visible mitral leaflet calcification was evident in seven of these patients, and the transmitral gradient for the group was significantly increased (from 4.8 +/- 1.7 mmHg to 8.3 +/- 3.9 mmHg, p = 0.04). Two patients required reoperation for failed mitral repair; one at six months due to chordal rupture, and one at 15 months due to mitral calcification with stenosis. CONCLUSION: Despite good early surgical results, there was accelerated calcification of the repaired mitral valve, a rapid increase in postoperative mitral gradients, and a high incidence of failure of the reconstruction. Additional prospective studies are required to evaluate the optimal intervention for patients with end-stage renal failure who require mitral valve surgery.     

Analysis of lupus activity in end-stage renal disease treated by hemodialysis

OBJECTIVE: The activity of systemic lupus erythematosus (SLE) has been reported to decrease in patients who have developed end-stage renal disease (ESRD). However, extrarenal symptoms attributable to the disease activity are noted, especially during the first year of dialysis. We studied the clinical course and evaluate the disease activity of SLE in patients with ESRD on hemodialysis for more than 6 months. SUBJECT AND METHODS: Fourteen patients with SLE who had been initiated on maintenance dialysis at our center between 1982 and 1999 were examined retrospectively. Their clinical details, organ system manifestations, serologic profiles and immunosuppressive treatment regimens were reviewed. Patients with and without postdialysis flaras of SLE were compared statistically. RESULTS: Five patients exhibited 6 SLE flares under treatment with corticosteroids. Two flares occurred within the first year of the initiation of dialysis, and in 1 patient, aggravation of the disease activity was noted 98 months after the initiation of dialysis. Polyarthritis was noted in 5 cases and fever in 4 cases. The serum complement levels decreased in all 6 cases with relapse of SLE activity. Compared with the other 9 patients who did not exhibit SLE relapse, no significant differences were found in 5 patients who did with respect to the demographic and serologic features at the initiation of dialysis. CONCLUSION: We conclude that the disease activity does not always burn out in patients of SLE who show progression to ESRD. SLE flares can sometimes occur even after one year of the initiation of dialysis. SLE patients on dialysis should be carefully followed up by clinical and serological monitoring, and treated by appropriate immunosuppressive therapy.     

Coronary artery bypass surgery in patients on chronic hemodialysis. A case-control study

STUDY OBJECTIVE: To determine the morbidity and mortality of cardiac catheterization and coronary artery bypass surgery in patients on chronic hemodialysis. DESIGN: Retrospective case-control study. SETTING: A referral-based university hospital. PATIENTS: Sixteen consecutive patients on chronic hemodialysis who had catheterization and bypass surgery: 30 controls matched for age, sex, year of operation, severity of coronary disease, left ventricular function, hypertension, diabetes, and urgency of surgery: and 34 consecutive controls having bypass surgery. MEASUREMENTS AND MAIN RESULTS: No major complications of catheterization occurred. Of 16 patients on dialysis, 7 had urgent surgery within 24 hours of catheterization. One patient on dialysis and 3 consecutive controls died, but none of the matched controls died. Postoperative morbidity was increased in the hemodialysis group as measured by the duration of mechanical ventilation (4.7 +/- 2.3 compared with 1.5 +/- 0.8 days in matched controls [mean +/- SE]), the duration of hemodynamic support (4.2 +/- 2.3 compared with 0.8 +/- 0.2 days), the length of stay in the intensive care unit (6.4 +/- 2.4 compared with 2.8 +/- 0.9 days), and the length of postoperative stay in the hospital (15.4 +/- 2.1 compared with 10.8 +/- 1.1 days) (all P less than 0.05). Four intraoperative myocardial infarctions occurred in patients on dialysis compared with two patients in the case-matched controls. Differences in morbidity between the two control groups were not significant. CONCLUSIONS: Morbidity is increased in patients on hemodialysis having coronary artery bypass surgery compared with controls matched for severity of coronary disease; however, the outcome in all but one patient on dialysis was good. Bypass surgery is an acceptable treatment for patients on dialysis with advanced coronary artery disease. Because urgent surgery is often needed in these patients, earlier evaluation of the need for revascularization may improve clinical results.     

The outcome of cardiac surgery in dialysis-dependent patients

BACKGROUND: Patients on dialysis for end-stage renal failure (ESRF) are undergoing cardiac surgery with increasing frequency. Furthermore, ESRF is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass. AIMS: To evaluate the outcome of dialysis-dependent patients undergoing cardiac surgery at one institution. METHODS: A retrospective analysis was performed on consecutive patients with ESRF dependent upon maintenance haemodialysis or peritoneal dialysis who underwent cardiac surgery from January 1998 to August 2002. RESULTS: Thirty-eight patients on dialysis underwent cardiac surgery during this time period (1.5% of total cases). The most common cause for ESRF was diabetic nephropathy (n = 12). Operations performed included isolated coronary artery bypass grafting (CABG, n = 22), CABG and valve surgery (n = 8), and valve surgery alone (n = 6). When allowing for age, sex, surgeon and operative category, the odds ratio for mortality risk of dialysis patients, compared with all others, was 4.9 (95% confidence interval (CI): 1.7-13.9, p = 0.003), and for morbidity risk, was 2.8 (95% CI: 1.4-5.4, p = 0.003). CONCLUSIONS: Patients on dialysis have an increased morbidity and mortality following cardiac surgery, however we believe ESRF should not be regarded as an absolute contraindication to cardiac surgery or cardiopulmonary bypass.     

Preoperative dialysis for liver transplantation in methylmalonic acidemia

Dialysis immediately before liver transplantation for patients with methylmalonic academia (MMA) with the mut0 mutation is considered to be necessary to reduce plasma methylmalonic acid (MMA) levels and prevent metabolic decompensation for a successful surgical outcome; however, this has not yet been conclusively confirmed. Ten pediatric patients underwent living donor liver transplantation at the National Center for Child Health and Development, Tokyo, Japan. Seven patients received dialysis immediately before surgery, but the three most recent patients did not receive dialysis. We monitored plasma MMA levels and evaluated metabolic status during the perioperative period. Plasma MMA levels of patients who received preoperative dialysis were significantly decreased. However, lactic acidosis developed in two patients during surgery. One of the patients who had decreased renal function suffered from severe lactic acidosis after the transplantation and died on post operative day 44. In the three patients who did not receive preoperative dialysis, high plasma MMA levels persisted, but they did not develop metabolic decompensation. Their plasma MMA levels gradually decreased after transplantation. Our results indicated that reducing MMA with preoperative dialysis does not decrease the risk of metabolic decompensation. We will need to evaluate whether preoperative dialysis is necessary for the success of surgery with more cases in the future. Adequate perioperative glucose infusion and careful lactate monitoring are pivotal for success.     

Long-term outcomes of scleroderma renal crisis

BACKGROUND: Although scleroderma renal crisis, a complication of systemic sclerosis, can be treated with angiotensin-converting enzyme (ACE) inhibitors, its long-term outcomes are not known. OBJECTIVE: To determine outcomes, natural history, and risk factors in patients with systemic sclerosis and scleroderma renal crisis. DESIGN: Prospective observational cohort study. SETTING: University program specializing in scleroderma. PATIENTS: 145 patients with scleroderma renal crisis who received ACE inhibitors and 662 patients with scleroderma who did not have renal crisis. MEASUREMENTS: Among patients with renal crisis, the four outcomes studied were no dialysis, temporary dialysis, permanent dialysis, and early death. Demographic, clinical, and laboratory data were compared to identify risk factors for specific outcomes. Follow-up was 5 to 10 years. RESULTS: 61% of patients with renal crisis had good outcomes (55 received no dialysis, and 34 received temporary dialysis); only 4 of these (4%) progressed to chronic renal failure and permanent dialysis. More than half of the patients who initially required dialysis could discontinue it 3 to 18 months later. Survival of patients in the good outcome group was similar to that of patients with diffuse scleroderma who did not have renal crisis. Some patients (39%) had bad outcomes (permanent dialysis or early death). CONCLUSIONS: Renal crisis can be effectively managed when hypertension is aggressively controlled with ACE inhibitors. Patients should continue taking ACE inhibitors even after beginning dialysis in hopes of discontinuing dialysis.     

Benefits of every other day dialysis (EODD) without rest for 72 hours in patients with symptomatic cardiovascular disease

With the purpose to improve the clinical situation of nine hemodialysis patients who suffer from severe cardiovascular disease and are highly symptomatic after weekends without dialysis because of fluid overload, their dialysis schedule was changed from 5 hours in 3 sessions per week to 4 hours every other day sessions (EODD), avoiding 72 hours of interdialitic weekend period. In each patient, during 38 sessions previous to starting the EODD (stage 1: 3 months) and the 38 sessions in EODD, which followed the first month of this dialysis regime (stage 2), the frequency of the next incidences was registered (ratio in 348 sessions, in every stage, of this patients group): presence of dysnea and/or hypertension pre dialysis session, pre or intra dialysis angor, emergency sessions with hypotension and sessions without achieving predetermined dry-weight. During the EODD stage, sessions, with dysena, hypertension and pre or intra dialysis angor were reduced in 80% (p < 0.001); the incidence of sessions with hypotensive episode or sessions without achieving dry-weight decreased in a third. All patients experimented a considerable improvement in their clinical situation. In addition, the whole group reduced dry-weight and later regained it without presenting symptoms which had motivated EODD schedule. EODD schedule improves the clinical situation in patients with cardiopathy who would not do so when following previous schedule (which includes 48 hours without dialysis).