Jaeger J Q, Mehta R L
Department of Medicine, University of California, San Diego, USA.
J Am Soc Nephrol. 1999 Feb;10(2):392-403. doi: 10.1681/ASN.V102392.
Fluid balance is an integral component of hemodialysis treatments to prevent under- or overhydration, both of which have been demonstrated to have significant effects on intradialytic morbidity and long-term cardiovascular complications. Fluid removal is usually achieved by ultrafiltration to achieve a clinically derived value for "dry weight." Unfortunately, there is no standard measure of dry weight and as a consequence it is difficult to ascertain adequacy of fluid removal for an individual patient. Additionally, there is a lack of information on the effect of ultrafiltration on fluid shifts in the extracellular and intracellular fluid spaces. It is evident that a better understanding of both interdialytic fluid status and fluid changes during hemodialysis is required to develop a precise measure of fluid balance. This article describes the current status of dry weight estimation and reviews emerging techniques for evaluation of fluid shifts. Additionally, it explores the need for a marker of adequacy for fluid removal.
液体平衡是血液透析治疗的一个重要组成部分，以防止水合不足或水合过度，这两者都已被证明对透析期间的发病率和长期心血管并发症有显著影响。液体清除通常通过超滤来实现，以达到临床上得出的“干体重”值。不幸的是，目前尚无干体重的标准测量方法，因此很难确定个体患者的液体清除是否充分。此外，关于超滤对细胞外和细胞内液空间中液体转移的影响，目前还缺乏相关信息。显然，为了制定精确的液体平衡测量方法，需要更好地了解透析间期的液体状态和血液透析期间的液体变化。本文描述了干体重估计的现状，并综述了评估液体转移的新兴技术。此外，还探讨了对液体清除充分性标志物的需求。
