低钠透析对血液透析患者大动脉僵硬度的影响

目的大动脉僵硬度的金标准--腹主动脉脉搏波传导速度(pulse wave velocity,PWV)是终末期肾脏病患者全因死亡和心血管死亡的独立危险因素。在非透析人群,饮食钠摄入增多可升高PWV;反之,限盐可降低PWV。本研究旨在观察应用低钠透析液增加透析钠清除对血液透析患者大动脉僵硬度的影响。方法选择处于干体质量的稳定血液透析患者16名。先应用标准透析液(钠浓度138mmol/L)透析一1个月,再将透析液钠浓度降为136mmol/L透析4个月(低钠透析)。研究期间未对饮食钠进行限制和干预,并且每个月应用生物电阻抗仪对干体质量进行调节,以保持透析后容量状态稳定。同时测量PWV、44h动态血压,记录透析间期体质量增长、每月透析中低血压和肌肉痉挛的发生率。结果随着低钠透析,腹主动脉PWV显著下降(12.61±2.30比11.74±2.65m/s,P=0.005);44h动态收缩压和舒张压分别较基线水平下降10mmHg和6mmHg(1mmHg=0.133kpa),而透析后容量状态无明显变化;透析间期体重增长轻度下降(2.89±0.66比2.67±0.63kg,P=0.051)。低血压和肌肉痉挛的发生率无明显变化。结论降低透析液钠浓度可显著改善透析患者的大动脉僵硬度。

The effect of lower sodium concentration in dialysate on arterial stiffness in hemodialysis patients

Objective Aortic stiffness, as evaluated by pulse wave velocity (PWV), is an independent predictor for all-cause mortality and cardiovascular mortality in hemodialysis (HD) patients. In general population, dietary salt loading increases PWV significantly, and lower sodium intake decreases PWV. In this study, we investigated whether the increase of sodium removal during dialysis by lower sodium concentration in dialysate could improve arterial stiffness in HD patients. Methods A total of 16 stable HD patients without chronic volume overload were enrolled. After one month period of dialysis using routine dialysate (138 mmol/ L sodium), patients were treated with dialysate of lower sodium concentration (136 mmol/L sodium) in HD for 4 months, without change of instructions about dietary sodium control. During the study period, dry weight was adjusted monthly with the help of bioimpedance spectroscope to maintain post-dialysis volume status in a steady state. PWV and 44-hour ambulatory blood pressure were measured. Results After the treatment for 4 months, PWV significantly decreased from 12.61 ± 2.30 to 11.74 ± 2.65 m/s (P=0.005). The 44-hour systolic and diastolic blood pressures were significantly lower than those at baseline (-10 mmHg and -6 mmHg, respectively), without change of post-dialysis volume parameters. Interdialytic weight gain decreased slightly from 2.89 ± 0.66 kg to 2.67 ± 0.63 kg (P=0.051). Conclusion Lower sodium concentration in dialysate improves arterial stiffness and blood pressure in HD patients.