Sodium modelling and profiled ultrafiltration in conventional haemodialysis

Summary: Previous controlled studies have shown that sodium modelling may reduce intradialytic hypotension and symptoms (particularly cramp, headache and nausea) in patients on maintenance haemodialysis, and it has been proposed that decremental profiled ultrafiltration may improve haemodynamic stability. Those controlled studies of sodium modelling were flawed because sodium modelling programmes were compared to a constant sodium dialysate concentration lower than the overall mean sodium concentration during sodium modelling (the ‘true mean’). to compare sodium modelling to its true mean constant dialysate concentration and also to compare profiled ultrafiltration with constant ultrafiltration, 12 patients on conventional haemodialysis were dialysed by four regimens in random order each for 3 weeks: (i) sodium modelling (exponential decline from 150 to 140 mmol/L) and conventional (linear) ultrafiltration; (ii) sodium modelling and profiled (65% of target loss in first 2 h) ultrafiltration; (iii) constant sodium (143 mmol/L, the true mean) and conventional ultrafiltration; and (iv) constant sodium and profiled ultrafiltration. Weight gain and pre-dialysis blood pressure were no different between the four regimens. Sodium modelling had no effect on the frequency of intradialytic hypotension or need for saline administration when compared to a constant sodium dialysate of 143 mmol/L, nor improved frequency or severity of thirst, cramp, nausea and lethargy. Interdialytic headache was less severe (P<0.05) but no less frequent with sodium modelling. Profiled ultrafiltration increased the frequency of intradialytic hypotension (odds ratio 2.44, P<0.05) and did not improve symptoms except interdialytic thirst, which occurred less frequently than with linear ultrafiltration (odds ratio 0.55, P<0.05). the haemodynamics and symptoms were no better with sodium modelling and profiled ultrafiltration than with constant sodium dialysis and linear ultrafiltration, respectively. Thus, there is no justification for the routine use of sodium modelling or profiled ultrafiltration in conventional haemodialysis on the grounds of haemodynamic stability or symptom control.     

透析液钙浓度对血液透析病人QT间期及QT间期离散度的影响

探讨透析液钙浓度变化对血液透析病人QT间期及QT间期离散度的影响。对15例慢性肾衰长期维持性血液透析病人先后应用钙浓度为1．25mmol／L（dCa^2 ＋1．25）、1．5mmol／L（dCa^2 ＋1．5）及1．75mmol／L（dCa^2 ＋1．75）的透析液各连续进行5次血液透析，分别于第5次透析时观察透析前后有关临床及实验室指标，测量并计算QT间期（QT）及QT间期离散度（QTd）。结果显示，采用dCa^2 ＋1．25血液透析时，血总钙血清Ca^2 明显下降（P＜0．05），QT明显延长、QTd明显增大（P＜0．05）；采用dCa^2＋1．5及dCa^2＋1．75血液透析时，血总钙及血清Ca^2 明显升高（P＜0．05），QT在dCa^2＋1．5透析时有缩短趋势，但差异无显著性意义（P＞0．05），而在dCa^2＋1．75透析时明显短（P＜0．05），QTd在dCa^2＋1．5及dCa^2＋1．75透析时虽有增大趋势，但差异无显著性意义（P＞0．05）。提示不同钙浓度的透析液进行血液透析引起QTd增大，但只有低钙血液透析时在引起QT明显延长的同时，QTd才明显增大，从而增加发生心律失常，尤其是发生室性心律失常的可能性。     

血液灌流与血液透析联合治疗尿毒症顽固性皮肤瘙痒临床分析

目的探讨血液灌流(HP)器与血液透析(HD)器串联治疗尿毒症顽固性皮肤瘙瘁的临床结果。方法维持性透析的尿毒症患者100例,随机分为两组,串联组(HP+HD组)50例,采用透析器与灌流器(HA型)串联进行治疗,每月2次,常规透析中其余6次净化方法为HD治疗;对照组(HD组)50例,单纯进行血液透析,外用乳化剂,口服抗组胺药物治疗皮肤症状,每月2次,每次4.h,均采用肝素抗凝,血流量200 mL/min。透析液为碳酸氢盐,流速为500mL/min。串联组先血液灌流及透析2h后再单纯透析2h,共治疗3个月。治疗前后检测Scr,BuN,用放射免疫法测定血液PTH水平,比较2组的肾小球过率(GFR)和透析时间。结果(1)HP+HD组患者治疗后PTH的清除率为(51.1±4.28)%,治疗前后比较差异有统计学意义(P<0.05);皮肤瘙痒缓解率为92.0%。(2)HD组的PTH清除率为(15.9±5.27)%;治疗前后比较差异无统计学意义(P>0.05),皮肤瘙痒缓解率为20.0%。结论血液灌流器与透析器串联治疗尿毒症顽固性皮肤瘙痒能有效消除PTH,缓解皮肤瘙痒症状。血液透析不能有效清除PTH,也不能缓解皮肤瘙。     

Long-Term Effect of Different Dialysate Calcium Concentrations on Parathyroid Hormone Levels in Hemodialysis Patients

The appropriate dialysate calcium concentration (D[Ca]) for hemodialysis (HD) therapy has not yet reached a consensus. We have conducted a prospective control study for five years on the effects of different D[Ca] on serum intact parathyroid hormone (iPTH) levels. Patients were divided into three groups receiving different D[Ca] therapies: the low-Ca (D[Ca]?=?2.5 mEq/L; N?=?96), mid-Ca (D[Ca]?=?3.0 mEq/L; N?=?121), and high-Ca (D[Ca]?=?3.5 mEq/L; N?=?82) groups. After five years' study, only 41 patients in the low-Ca group, 34 in the mid-Ca group, and 32 in the high-Ca group completed the study. The results demonstrated that serum corrected calcium concentrations were significantly lower in the low-Ca group compared with other groups in years 3 and 4, although the products of corrected calcium time phosphate did not show difference between each group.^Δserum alkaline phosphatase (^ΔAlk-p) to baseline levels increased significantly after the fourth year in all three groups (p < 0.05). Serum ^Δ iPTH only increased significantly after the fourth year in the low-Ca group (p < 0.05) but not in the other groups. There were no significant differences in the extent of ^ΔAlk-p and ^ΔiPTH between the groups. Cox proportional methods also showed no difference in cumulative survival between the groups. In conclusion, our results demonstrate that compared with the other two groups of D[Ca], long-term use of D[Ca] of 2.5 mEq/L was associated with relatively lower serum calcium concentration. Perhaps this was related to a greater extent of iPTH concentration elevation after five years.     

Clinical Outcome Following the Use of Inadequate Solutions for Continuous Veno-Venous Hemodiofiltration

Backgrounds. A short time ago, commercially available diafiltration and replacement fluids could be found o n the hospital in Turkey. Instead, peritoneal dialysis solution (PDS) for continue veno-venous hemodiafiltration (CVVHDF) therapy and normal saline as replacement fluid are used. In this retrospective study, we investigated the effects of PDS and bicarbonate-buffered hemofiltration solution (Bic-HFS). Methods. We did a retrospective chart review of 24 patients treated with continue renal replacement therapy (CRRT) between January 2004 and February 2008. Peritoneal dialysis solution (PDS) was used in 14 patients, and bicarbonate-buffered hemodialysis solution (bic-HFS) was used in 10 patients. Results. Demographic data, laboratory findings, and mortality rate were similar both groups. Blood glucose and lactate levels were higher in the PD group than the bic-HFS group (p < 0.05). Hyperglycemia occurred more frequent in the PDS group than in the bic-HFS group (64% versus 30%, respectively; p < 0.05). Metabolic acidosis occurred in eight patients (57%) in the PDS group and three patients (30%) in the bic-HFS group (p < 0.05). Hypotension was higher in the PDS group (10, 71%) than in the bic-HFS group (3, 30%; p < 0.05). Conclusion. Using PDS fluid as dialysate for CVVHDF therapy is not a preferable solution because of the metabolic disturbances that it can cause.     

含糖透析液对非糖尿病透析相关低血压患者血压和舒适状况的影响

目的探讨含糖透析液对非糖尿病透析相关低血压患者血压和舒适状况的影响。方法采用前瞻性、交叉对照研究,对102例透析相关低血压患者应用无糖透析液和含糖透析液透析进行交叉透析。观察患者透析中血压(第1小时、第2小时、第3小时)和心率情况;并采用Kolcaba舒适度量表进行舒适度评价。结果在应用含糖透析液后,非糖尿病透析相关低血压患者透析中第1小时、第2小时、第3小时的收缩压明显升高,收缩压最小值明显升高,且收缩压下降最大值明显降低(P0.01或P0.05);透析中第1小时舒张压明显降低(P0.01)。应用含糖透析液时有43例患者未再发生透析中低血压,其缓解率为42.16%。应用含糖透析液的非糖尿病透析相关低血压患者透析中第1小时、第2小时、第3小时的心率减慢(P0.01或P0.05)。应用含糖透析液的非糖尿病透析相关低血压患者舒适度总分和其心理、生理维度得分均增加(P0.01或P0.05)。结论含糖透析液可以明显改善维持性血液透析患者透析相关低血压,且提高患者的舒适度。     

B浓缩液不同配置方法所制备的透析液中所含微生物的定量研究

目的 降低透析液微生物污染,提高透析液质量,保证患者透析安全.方法 比较自行配制B浓缩液后分装到B液桶中供液、B浓缩液集中供液、使用联机Bibag干粉,3种不同的B浓缩液配置方式所制备的透析液中微生物含量的差异.结果 3种B浓缩液配置方法所制备的透析液中的微生物含量经统计学处理数据为F =4.186,P=0.017,P＜0.05,有非常显著的差异.其中A、B样本比较数据为t=3.225,P=0.002,P＜0.05;B、C样本比较数据为t=-2.24 P=0.027 P＜0.05,说明采用联机无菌Bibag干粉制备的透析液中内毒素含量明显少于其他两种方法.结论 使用联机Bibag干粉可以提高透析液质量.     

Evaluation of an in-line dialysate urea monitor including assessment of 'V'

Summary: Dialysate based assessment of the delivered dose of dialysis offers several advantages over blood sampling methods as it remains accurate in the face of fistula recirculation, urea rebound, variable blood flow and incorrect treatment time. Kr/V is calculated from the slope of the decline in urea concentration in the dialysate over the course of the treatment. By equilibrating dialysate with blood at the initiation of the treatment an estimate of pre-dialysis blood urea and the volume of distribution for urea (V) can be obtained. We performed Kt/V assessments on 20 in-centre haemodialysis patients using the Baxter Biostat 1000® dialysate urea monitor and compared the results with urea reduction ratios and Kt/V calculated by the formula of Basile. In addition, in 11 of these patients, V and pre-dialysis urea was derived and compared to total body water estimates using D₂O. the mean Kt/V by Biostat was 1.11 ± 0.23 and by formula was 1.23 ± 0.16 ( P < 0.005, Student's paired t -test). the lab pre-dialysis urea was 24.4 ± 6.2 mmol/L compared to the Biostat result of 23.9 ± 5.9 (when corrected for plasma water), with the mean difference of the techniques being −0.53 mmol/L. (95% CI −0.36–1.42). For V, the D₂O result was 36.7 ± 9.7 litres, compared to the Biostat result of 37.9 ± 9.6. the mean difference of the techniques by Bland and Altman analysis (or bias of the Biostat) was 1.2 L (95% CI −0.9–3.3) and the limits of agreement were −5.2–7.6L. Thus the Biostat provides easy access to dialysis adequacy data and gives a reasonable assessment of V, tending to overestimate this value.     

HPLC测定烧伤患者肾脏透析排出液中头孢噻肟钠的含量

目的　测定肾替代治疗的烧伤患者肾脏透析排出液中头孢噻肟钠的含量。方法　用HPLC ,μBondapak C18柱 ,流动相为甲醇 -醋酸钠 (0 0 2mol·L-1,pH 5 0 ) (30∶70 ) ,流速 1 2ml·min-1,检测波长 2 6 0nm。结果　在 1～ 10 0 μg·ml-1的范围内线性良好 ,r =0 9999;日内、日间RSD≤ 2 % ,平均回收率 10 0 2 %。结论　所用方法简便、快速、准确、可用于样品测定。