Katzarski K S, Charra B, Luik A J, Nisell J, Divino Filho J C, Leypoldt J K, Leunissen K M, Laurent G, Bergström J
Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
Nephrol Dial Transplant. 1999 Feb;14(2):369-75. doi: 10.1093/ndt/14.2.369.
Patients treated at the haemodialysis (HD) centre in Tassin, France have been reported to have superior survival and blood pressure (BP) control. This control has been ascribed to maintenance of an adequate fluid state, antihypertensive drugs being required in < 5% of the patients, although it could not be excluded that a high dose of HD regarding removal of uraemic toxins might also have been of value.
The aim of the study was to assess the fluid state and BP in normotensive patients on long HD (8 h) in Tassin (group TN) using bioimpedance to measure extracellular volume (ECV), ultrasound for determining the inferior vena cava diameter (IVCD), and 'on-line' monitoring of the change in blood volume (BV), and to compare them with normotensive (group SN) and hypertensive (group SH) patients on short HD (3-5 h) at centres in Sweden. ECV was normalized (ECVn) by arbitrarily setting the median ECV (in % of body weight) in SN patients at 100% for each gender, recalculating the individual values and combining the results for male and female patients in each group.
The dose of HD (Kt/V urea) was higher for TN patients than for Swedish patients who had a similar Kt/V, whether hypertensive or not. SH patients had significantly higher ECVn and IVCD than TN and SN patients. TN and SN patients did not differ significantly regarding ECVn and IVCD before and after HD. However, in a subgroup of eight TN patients, ECVn was below the range of that in SH and SN patients, due to obesity with a high body mass index. Another subgroup of 14 TN patients had a higher ECVn than most of the SN patients and also higher than the median ECVn in the SH group, without any difference in body mass index, but they were nevertheless normotensive. The fall in BV was greater in SN than in TN patients, presumably due to a higher ultrafiltration rate in SN patients. However, SH patients had a smaller change in BV than SN patients, presumably because their state of overhydration facilitated refilling of BV from the interstitial fluid.
Normotension can be achieved independently of the duration and dose (Kt/V urea) of HD, if the control of post-dialysis ECV is adequate. However, this is more difficult to achieve with short than with more prolonged HD during which the ultrafiltration rate is lower, BV changes are smaller and intradialysis symptoms less frequent. The results in the subgroup of patients with high ECVn at Tassin suggest that normotension may also be achieved in patients with fluid overload provided that the dialysis time is long enough to ensure more efficient removal of one or more vasoactive factors that cause or contribute to hypertension.
据报道，在法国塔桑血液透析（HD）中心接受治疗的患者具有更好的生存率和血压（BP）控制情况。这种控制归因于维持适当的液体状态，不到5%的患者需要使用抗高血压药物，不过不能排除高剂量的HD在清除尿毒症毒素方面可能也有价值。
本研究的目的是使用生物阻抗测量细胞外液量（ECV）、超声测定下腔静脉直径（IVCD）以及“在线”监测血容量（BV）变化，评估塔桑长期HD（8小时）的血压正常患者（TN组）的液体状态和血压，并将其与瑞典各中心短期HD（3 - 5小时）的血压正常患者（SN组）和高血压患者（SH组）进行比较。通过将SN组患者的ECV中位数（占体重的百分比）任意设定为每种性别的100%，重新计算个体值并合并每组男性和女性患者的结果，对ECV进行标准化（ECVn）。
TN组患者的HD剂量（Kt/V尿素）高于具有相似Kt/V的瑞典患者，无论后者是否患有高血压。SH组患者的ECVn和IVCD显著高于TN组和SN组患者。HD前后，TN组和SN组患者在ECVn和IVCD方面无显著差异。然而，在8名TN组患者的亚组中，由于高体重指数导致的肥胖，ECVn低于SH组和SN组患者的范围。另一个由14名TN组患者组成的亚组的ECVn高于大多数SN组患者，也高于SH组的ECVn中位数，体重指数无差异，但他们血压正常。SN组患者的BV下降幅度大于TN组患者，可能是因为SN组患者的超滤率更高。然而，SH组患者的BV变化小于SN组患者，可能是因为他们的水过多状态促进了间质液对BV的再填充。
如果透析后ECV控制得当，血压正常可独立于HD的持续时间和剂量（Kt/V尿素）实现。然而，与超滤率较低、BV变化较小且透析期间症状较少的较长时间HD相比，短时间HD更难实现这一点。塔桑ECVn高的患者亚组的结果表明，对于液体过载的患者，如果透析时间足够长以确保更有效地清除一种或多种导致或促成高血压的血管活性因子，也可能实现血压正常。
