高钠透析液在糖尿病肾衰竭患者血透中的临床应用

目的:观察高钠透析液对糖尿病肾衰竭维持血透患者的影响。方法:选取糖尿病肾衰竭维持血透患者30例,采用自身对照研究方法,分别用135 mmol/L、140 mmol/L及145 mmol/L钠浓度的透析液透析8周,观察疗效和不良反应发生的情况。结果:与使用135 mmol/L钠浓度透析液比较,使用140 mmol/L钠浓度的透析液可以显著降低低血压和肌痉挛的发生(P0.05)。与使用145 mmol/L钠浓度透析液比较(P0.05),使用140 mmol/L钠浓度的透析液不增加口渴及高血压等副作用。结论:对糖尿病肾衰竭维持血透的患者使用140mmol/L钠浓度的透析处方可以降低患者不良反应发生率。     

序贯钠透析在预防透析低血压中的应用

目的 :研究序贯钠透析对透析低血压的预防作用。方法 :对连续 4次血透中发生透析低血压≥ 2次的 16例应用序贯钠透析干预共 92次 ,观察血液透析中的血压变化和临床症状的改善情况 ,干预前次透析液钠浓度均为 14 0mmol/L ,序贯钠透析起始钠浓度为 15 0mmol/L ,逐渐降至 138mmol/L。结果 :应用序贯钠透析后 ,透析中最低血压、透析后和透析中的平均收缩压的升高显著 ,大于 10mmHg(P <0 .0 1) ,临床症状几乎完全消失 ,未发现患者有任何不耐受情况。结论 :应用序贯钠透析能够非常有效地预防透析低血压的发生 ,使透析过程更安全     

血液透析中超滤脱水对钙平衡的影响

目的　观察在单次透析中 ,使用钙浓度为 1.5mmol/L的透析液透析时超滤脱水对钙平衡的影响。方法　维持性血液透析患者 18例 ,使用钙离子浓度为 1.5mmol/L透析液。按透析脱水量将患者分为 2组 ,每组 9例 ,A组脱水量 >2 .0kg ,B组不脱水。透析前后检测患者血清总钙浓度 ;透析前即刻取新鲜透析液并留取透析过程中全部废液 ,测总钙浓度。结果　A组与B组透析前血总钙水平在正常范围 ,且没有差异 ( 2 .3 3mmol/L± 0 .13mmol/LVs 2 .2 0mmol/L± 0 .14 3mmol/L ,P >0 .0 5 )。A组的废透析液的总钙浓度为 1.5 5mmol/L± 0 .0 5mmol/L ,较新鲜透析液 ( 1.5 0mmol/L± 0 .0 5mmol/L)升高 ,P <0 .0 5 ,提示存在钙的外流。而B组废透析液总钙浓度为 1.5 0mmol/L± 0 .0 3mmol/L ,较新鲜透析液 ( 1.5 3mmol/L± 0 .0 6mmol/L)下降 ,P >0 .0 5。结论　对于透析前血钙浓度正常的患者 ,单次透析中 ,使用钙浓度为 1.5mmol/L的透析液进行透析时 ,超滤脱水对钙平衡有影响 ,大量脱水可导致钙的外流     

含糖透析液对糖尿病透析患者透析低血糖和低血压的影响

目的研究分析对糖尿病透析患者使用含糖透析液后低血糖和低血压的变化影响。方法选取该院2015年9月—2016年8月收治的30例糖尿病患者作为研究对象,在前3个月对患者使用无糖透析液,在后3个月对患者使用含糖透析液,研究使用的含糖透析液的浓度为5.5 mmol/L,然后对所有患者前后3个月透析低血糖与低血压的影响变化进行比较分析,并观察各种代谢指标的变化。结果对糖尿病透析患者使用含糖透析液,患者低血糖的发生率为1.72%,低血压的发生率为4.74%,显著低于使用无糖透析液的16.81%和11.64%,差异有统计学意义(P0.05),而且患者的糖化血红蛋白、白蛋白、血脂、血钾等代谢指标并没有出现显著变化,差异无统计学意义(P0.05)。结论使用含糖透析液对糖尿病透析患者进行透析,能够有效降低透析低血糖和低血压发生的概率,同时也不会隐形患者的其他代谢指标。     

可调钠血液透析对糖尿病肾衰竭患者透析低血压的作用分析

目的探讨可调钠血液透析对糖尿病肾衰竭患者透析低血压的作用。方法选取2015年7月—2017年9月于该院行血液透析的50例糖尿病肾衰竭患者为研究对象,随机分为观察组25例和对照组25例,对照组给予常规血液透析,观察组行可调钠血液透析,对比两组低血压发生情况和透析前后的血压浓度。结果两组患者透析后血钠浓度均有一定的提高,但提高,差异无统计学意义(P0.05)。观察组透析后血钠浓度和对照组对比,差异无统计学意义(P0.05)。两组透析中血压值和透析前对比,差异有统计学意义(P0.05),观察组透析中血压值变化和对照组对比(P0.05)。观察组低血压发生几率和对照组对比,差异有统计学意义(P0.05)。结论在糖尿病肾衰竭患者透析在应用可调钠血液透析可以降低低血压发生几率,不会影响正常的透析效果。     

低钙透析液对血甲状旁腺素及钙磷代谢的影响

目的:研究应用钙离子 1 .25mmol/L透析液进行透析 3个月对患者iPTH及钙磷水平的影响。　方法:维持性血液透析患者 6例,试验前用钙离子 1. 5mmol/L透析液每周透析 3次,每次透析 4h,均使用F6透析器(聚砜膜,面积 1 3m2 )。使用钙离子 1 25mmol/L透析液透析 3.个月,此期患者饮食中钙磷的摄入量稳定,用药不变。使用钙离子 1 25mmol/L透析液之前检测透析前血iPTH,透析前后血钙和血磷浓度。3个月后复查透析前血iPTH,透析前后血钙和血磷浓度,并检测使用钙离子 1. 25mmol/L透析液单次透析前、透析后及下一次透析前的血iPTH和血钙、血磷浓度。　结果:单次透析使用钙离子浓度 1 25mmol/L的透析液透析 4h,透后血钙浓度下降,透后血iPTH[ (219 .2±143. 3)ng/L]较透前[ (157. 5±107 .1)ng/L]明显升高 (P<0. 05),至下次透析前血钙浓度及血iPTH(157. 7±125 .3ng/L)基本恢复至上次透析前水平。使用钙离子 1 25mmol/L透析液透析 3个月后,iPTH水平较未使用时明显上升[ (157. 5±107 .1)ng/Lvs(82. 5±43 .7)ng/L,P<0 .05]。　结论:单次应用钙离子 1 .25mmol/L透析液进行透析, 透后血iPTH升高,但是至下一次透前血iPTH基本恢复至上次透前水平。长期应用 ( 3个月)钙离子 1 25mmol/L透析液进行透析,钙负荷减轻,血iPTH水平升     

夜间血液透析病人不使用任何磷结合剂控制血浆磷

高磷血症是慢性肾衰竭病人的早期表现之一，它在继发性甲状旁腺分泌亢进症的发生中起重要作用。尽管预防和治疗高磷血症的方法很多，但都不尽人意。本研究的目的是评价夜间血液透析（NHD）——一种新的透析模式对终末期肾衰竭病人血浆磷的清除及其长期效果。方法短期研究：目的是比较NHD和CHD（常规血透）对磷清除的效果及透析过程中和透析后血浆磷水平即时变化的动力学。8例病人采用自身对照的方法，先CHD4周，每周透析3次，每次透析4小时，透析器为FreseniusF80，血流量300～500ml／min，透析液流量500ml／min，透析液成分（mmol／L…     

低钙透析液对血液透析过程中血压升高患者血压血钙及内皮素的影响研究

目的 研究低钙离子浓度透析液对维持性血液透析患者透析过程中血压、血清钙离子(Ca2+)、内皮素(ET-1)的影响.方法 选择2007年3月至2008年3月中国医科大学附属盛京医院60例透析过程中血压升高的尿毒症患者,先后使用钙离子浓度为1.75 mmol/L(DCa1.75)和1.25mmol/L(DCa1.25)的透析液进行血液透析,监测透析前后血压、血Ca2+、ET-1的变化.结果 透析过程中血压升高的尿毒症患者应用DCa1.75的透析液,透析后的血压、血Ca2+、ET-1比透析前以及使用DCa1.25的透析液透析后血压、血Ca2+、ET-1浓度均明显升高(P<0.05).结论 应用低钙透析液能够避免高钙透析液导致的血液透析过程中血压升高问题.     

透析液钙离子浓度对维持性血液透析患者血全段甲状旁腺激素的影响

目的评价不同钙离子浓度的透析液对维持性血液透析(MHD)患者血全段甲状旁腺激素(iPTH)的影响,分析血钙、磷和钙磷乘积与iPTH之间的相关性。方法对2006年1月至3月,上海交通大学医学院附属新华医院肾内科门诊35例长期使用钙离子浓度为1·75mmol/L的透析液进行维持性血液透析的患者,于透析前留取血标本进行血Ca2 、P3-、iPTH测定,并计算钙磷乘积后,改为钙离子浓度为1·25mmol/L或1·50mmol/L的透析液进行维持性血液透析,3个月后于透析前再次留取血标本进行血Ca2 、P3-、iPTH测定,并计算钙磷乘积。结果与使用钙离子浓度为1·75mmol/L透析液比较,使用钙离子浓度为1·25mmol/L或1·50mmol/L透析液3个月后,MHD患者血Ca2 、P3-、钙磷乘积差异无显著性意义,P>0·05,血iPTH明显升高,P<0·01。血iPTH与Ca2 呈显著性负相关,r=-0·45,P<0·01;与P3-及钙磷乘积无相关性,r分别为0·13和-0·03,均P>0·05。结论1·25mmol/L或1·50mmol/L的低钙透析液可以升高MHD患者血清iPTH水平。     

普通含钙透析液分段枸橼酸抗凝与无肝素透析在高危出血透析患者中的应用

目的 ：观察应用普通含钙透析液分段局部枸橼酸抗凝（regional citrate anticoagulation,RCA）的安全性、有效性。与无肝素透析比较在高危出血患者中凝血情况、治疗时间的差异。方法：选取大连市中心医院2019年1月至2021年12月有高危出血风险的维持性血液透析患者35例,其中男性19例,女性16例。分别予以无肝素透析和4%枸橼酸钠局部抗凝治疗,枸橼酸应用输液泵分别自管路动脉端和静脉壶处持续泵入。比较RCA应用前后患者血离子情况、血压变化和出凝血时间影响。比较2种方法凝血情况、透析时间的差异。结果：枸橼酸组患者通过在线调整透析机参数,透析后血钠可以维持平稳（P>0.05）。应用含钙透析液（1.5 mmol/L）,无低钙血症发生,透析后血钙较透析前升高（P<0.05）。枸橼酸组患者透析前后血压、心率平稳,无明显变化（P>0.05）,随着透析时间延长,静脉压、跨膜压有所升高（P<0.05）。RCA治疗后患者活化部分凝血活酶时间（activated partial thromboplastin time,APTT）较透析前延长（P<0.0...     

Impact of Dialysate Sodium Concentration Lowering on Home Blood Pressure Variability in Hemodialysis Patients

Blood pressure variability is an independent risk factor for mortality and cardiovascular events in hemodialysis patients. Dialysate sodium concentration may not only have effects on blood pressure but also on blood pressure variability. We investigated whether dialysate sodium concentration lowering could decrease home blood pressure variability in hemodialysis patients. Forty‐three hemodialysis patients at their dry weight assessed by bioimpedance methods with pre‐dialysis serum sodium >136 mmol/L were recruited. Firstly, patients underwent a 1‐month standard dialysis with dialysate sodium concentration of 138 mmol/L, and then the dialysate sodium concentration was decreased to 136 mmol/L for 8 weeks. Home blood pressure was assessed on waking up and at bedtime for 1 week. Coefficient of variation was used to define home blood pressure variability. After the intervention, whole‐day systolic blood pressure variability decreased from 5.7 ± 2.6% to 4.3 ± 1.7% and evening systolic blood pressure variability decreased from 7.9 ± 4.1% to 6.2 ± 3.1%. Morning systolic blood pressure variability had a reduction from 7.8 ± 2.4% to 5.9 ± 3.3% but did not achieve statistical significance (P = 0.077). Whole‐day, morning and evening systolic blood pressure were decreased significantly. Less changes were observed in diastolic blood pressure parameters. Interdialytic weight gain mildly but significantly decreased. Volume parameters, dietary sodium intake and incidence of adverse events were similar throughout the study period. Lowering dialysate sodium concentration could improve home blood pressure variability among hemodialysis patients who had achieved their dry weight.     

托伐普坦治疗心力衰竭患者低钠血症的疗效和安全性

目的 评价在常规治疗基础上应用托伐普坦治疗心力衰竭(心衰)合并低钠血症的疗效和安全性.方法 多中心入选65例心衰合并低钠血症患者,随机、双盲分为托伐普坦组和安慰剂组.根据血钠情况,分别每日服用15 ～60 mg托伐普坦片或安慰剂.主要评价指标为服药第1～4天和第1～7天的日均血钠值与基线血钠值相比的变化.观察患者体重、尿量、心衰体征、心功能、血压、心率及不良事件,进行疗效及安全性评估.结果 治疗第1～4天和第1～7天,托伐普坦组日均血钠增加值分别为(5.6±3.5) mmol/L和(5.9±3.5) mmol/L,显著优于安慰剂组的(2.5±3.4) mmol/L和(2.8±3.3) mmol/L,P＜0.05.托伐普坦组尿量增加和体重下降优于安慰剂组(P＜0.05).两组患者治疗前后心衰体征、心功能、血压和心率变化差异无统计学意义(P＞0.05).托伐普坦组常见药物相关不良反应为口渴(11.4％)和血钠升高(5.7％),另发生1例粒细胞缺乏严重不良事件,考虑与试验药物可能有关,经治疗恢复.结论 托伐普坦有效纠正心衰患者低钠血症,增加尿量,改善液体平衡,总体耐受性良好,严重不良事件的发生率低.     

Effects of Sodium Concentration and Dialysate Temperature Changes on Blood Pressure in Hemodialysis Patients: A Randomized,Triple‐Blind Crossover Clinical Trial

The present study investigated the effects of different temperatures and sodium dialysate concentration on blood pressure in hemodialysis patients. Following Williams’ design, hemodialysis patients were randomly assigned into four dialysis modes. Dialysate temperature was set at 37°C for modes A and C and, 35°C for modes B and D. Sodium concentration was set at 138 mmol/L in modes A and B, while it changed from 150 mmol/L to 138 mmol/L in modes C and D. Using analysis of variance for repeated measures, the mean values of systolic and diastolic blood pressure were investigated. The mean values of systolic and diastolic blood pressure in modes C and D had a significant difference with the values in mode A. The mean values of systolic and diastolic blood pressure in patients dialyzed with mode B had a significant difference with the values in those dialyzed with mode D. Moreover, there were significant differences in the incidence of hypotension between A and other modes and between B and modes C and D, but this difference was not significant between modes C and D. In order to reduce intradialytic blood pressure fluctuations and hypotension, the nursing staff are recommended to gradually reduce dialysate sodium concentration.     

肾综合征出血热并发低钠性脑水肿临床特征及甘露醇联合高钠血液透析疗效分析

目的 分析肾综合征出血热(HFRS)并发低钠性脑水肿患者临床特征,并观察甘露醇联合高钠血液透析治疗的疗效.方法 83例HFRS并发低钠性脑水肿患者随机分为高钠透析组41例和对照组42例,比较两组患者治疗后血清钾、钠、氯、肌酐和渗透压的水平以及血钠复常率、复常时间和病死率.采用t或χ2检验进行统计学分析.结果 高钠透析组患者治疗后血钠、氯、渗透压分别为(128.9±7.3)mmol/L、(96.7±6.2)mmol/L、(253.1±7.5)mOsm/L,明显高于对照组的(117.8±7.1)mmol/L、(92.2±6.9)mmol/L、(242.1±8.4)mOsm/L(t=7.14,t=3.12,t=15.22;均P＜0.05).19例中度低钠性脑水肿高钠透析组和19例对照组患者血钠复常例数分别为12例和6例(χ2=3.867,P=0.049),两组血钠复常时间分别为(4.9±1.3)d和(8.3±1.9)d(t=6.438,P=0.001).14例重度低钠性脑水肿高钠透析组和14例对照组患者血钠复常例数分别为7例和2例(χ2=4.094,P=0.043),两组血钠复常时间分别为(7.85±1.9)d和(11.6±2.8)d(t=3.235,P=0.034).高钠透析组病死率为36.6%(15/41例),明显低于对照组的61.9%(26/42例)(χ2=5.321,P=0.021).结论 HFRS并发低钠性脑水肿患者病情严重,甘露醇联合高钠血液透析治疗能有效地提高中、重度低钠性脑水肿患者血钠复常率,缩短复常时间,降低病死率.     

Plasma norepinephrine, epinephrine, and dopamine levels in end-stage renal disease. Effect of hemodialysis

The effect of hemodialysis on plasma norepinephrine (NE), epinephrine, and dopamine levels was studied in 11 patients undergoing maintenance hemodialysis. The results showed that the baseline plasma concentrations of NE and dopamine were significantly elevated in patients with end-stage renal disease undergoing maintenance hemodialysis. Intradialysis weight loss and fall in the serum glucose concentration during dialysis correlated with changes in plasma epinephrine and NE concentrations. Single-pass dialysis resulted in a marked reduction in the plasma NE concentration, indicating significant removal by dialysis. These observations should be taken into consideration when interpreting plasma catecholamine data obtained in the course of investigation of hypertensive patients with end-stage renal disease.     

Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure

PURPOSE: The development of life-threatening hyperkalemia poses a risk for patients with chronic preterminal renal failure. Various therapeutic options have been suggested for hyperkalemic emergencies in these patients; to date, however, no study has evaluated the relative efficacies of these measures in the presence of renal failure. Our goal was to examine the acute effects of a variety of therapeutic approaches, as well as those of hemodialysis, on plasma potassium levels in a hemodialysis population. PATIENTS AND METHODS: Ten patients with terminal renal failure undergoing maintenance hemodialysis were enrolled in the study. Blood gas parameters and plasma sodium, potassium, glucose, osmolality, renin, aldosterone, epinephrine, norepinephrine, dopamine, and insulin were measured before, during, and after 60-minute infusions of bicarbonate, epinephrine, and insulin in glucose, and before, during, and after performance of regular hemodialysis for one hour. RESULTS: Hypertonic as well as isotonic intravenous bicarbonate (2 to 4 mmol/minute) induced a marked rise in plasma bicarbonate and pH, but failed to lower the plasma potassium level (5.66 versus 5.83 mmol/liter before and after). Epinephrine, 0.05 microgram/kg/minute administered intravenously, decreased plasma potassium only slightly from 5.57 to 5.25 mmol/liter, and five patients showed no decline. On the other hand, insulin in glucose, 5 mU/kg/minute intravenously, effectively lowered plasma potassium levels from 5.62 to 4.70 mmol/liter, and hemodialysis induced the most rapid decline from 5.63 to 4.29 mmol/liter. Plasma aldosterone was elevated before treatment; it correlated with plasma potassium and dropped during intravenous bicarbonate administration or hemodialysis. Pretreatment plasma renin activity, insulin, epinephrine, norepinephrine, and dopamine levels were generally normal. CONCLUSION: We conclude that in patients with terminal renal failure undergoing maintenance hemodialysis, intravenous bicarbonate is ineffective in lowering plasma potassium rapidly, and epinephrine is effective in only half the patients, whereas insulin in glucose is a fast and reliable form of therapy for hyperkalemic emergencies. Plasma aldosterone levels are appropriate in relationship to plasma potassium levels, and levels of other potassium-influencing hormones are generally normal.     

Lactic acidosis associated with standard dose linezolid in a kidney recipient with impaired renal function

Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism.     

Renal protection for coronary angiography in advanced renal failure patients by prophylactic hemodialysis. A randomized controlled trial.

OBJECTIVES: We performed a study to determine whether prophylactic hemodialysis reduces contrast nephropathy (CN) after coronary angiography in advanced renal failure patients. BACKGROUND: Pre-existing renal failure is the greatest risk factor for CN. Hemodialysis can effectively remove contrast media, but its effect upon preventing CN is still uncertain. METHODS: Eighty-two patients with chronic renal failure, referred for coronary angiography, were assigned randomly to receive either normal saline intravenously and prophylactic hemodialysis (dialysis group; n = 42) or fluid supplement only (control group; n = 40). RESULTS: Prophylactic hemodialysis lessened the decrease in creatinine clearance within 72 h in the dialysis group (0.4 +/- 0.9 ml/min/1.73 m(2) vs. 2.2 +/- 2.8 ml/min/1.73 m(2); p < 0.001). Compared with the dialysis group, the serum creatinine concentrations in the control group were significantly higher at day 4 (6.3 +/- 2.3 mg/dl vs. 5.1 +/- 1.3 mg/dl; p = 0.010) and at peak level (6.7 +/- 2.7 mg/dl vs. 5.3 +/- 1.5 mg/dl; p = 0.005). Temporary renal replacement therapy was required in 35% of the control patients and in 2% of the dialysis group (p < 0.001). Thirteen percent of the control patients, but none of the dialysis patients, required long-term dialysis after discharge (p = 0.018). For the patients not requiring chronic dialysis, 13 patients in the control group (37%) and 2 in the dialysis group (5%) had an increase in serum creatinine concentration at discharge of more than 1 mg/dl from baseline (p < 0.001). CONCLUSIONS: Prophylactic hemodialysis is effective in improving renal outcome in chronic renal failure patients undergoing coronary angiography.     

Potassium-lowering effect of albuterol for hyperkalemia in renal failure

To study the effect of specific beta 2-adrenergic stimulation on potassium metabolism in renal failure, we intravenously administered albuterol (Salbutamol) sulfate, 0.5 mg, to 20 patients with chronic renal failure (glomerular filtration rate, less than 5 mL/min) receiving maintenance hemodialysis. Within 30 minutes after albuterol administration, serum potassium level dropped from 5.6 +/- 0.2 (+/- SEM) to 4.5 +/- 0.2 mEq/L (5.6 +/- 0.2 to 4.5 +/- 0.2 mmol/L). There were no changes in plasma aldosterone levels or arterial pH, but blood glucose and serum insulin levels increased. Albuterol, however, induced similar decreases in serum potassium levels in three diabetic patients while free C peptide levels remained undetectable or subnormal after administration of the drug. Albuterol sulfate alone (0.5 mg intravenously) was also used to treat 24 patients with acute or chronic renal failure and hyperkalemia. Their serum potassium levels dropped from 7 +/- 0.2 mEq/L (7 +/- 0.2 mmol/L) to 5.6 +/- 0.2 mEq/L (5.6 +/- 0.2 mmol/L), 5.6 +/- 0.2 mEq/L (5.6 +/- 0.2 mmol/L), 6 +/- 0.2 mEq/L (6 +/- 0.2 mmol/L), and 6.2 +/- 0.2 mEq/L (6.2 +/- 0.2 mmol/L) at 30, 60, 180, and 360 minutes after receiving albuterol, respectively, and this was accompanied by reversal of the electrocardiographic manifestations of hyperkalemia. Despite inducing transient tachycardia, albuterol was remarkably well tolerated and no serious side effects were observed. beta 2-adrenergic stimulation of intracellular potassium uptake by albuterol is a safe and effective alternative for the treatment of hyperkalemia in renal failure.