Keijman J M, van der Sande F M, Kooman J P, Leunissen K M
Department of Internal Medicine and Nephrology, University Hospital Maastricht, The Netherlands.
Nephrol Dial Transplant. 1999 Sep;14(9):2196-200. doi: 10.1093/ndt/14.9.2196.
Haemodynamic stability is better maintained during isolated ultrafiltration (i-UF) than during combined ultrafiltration/haemodialysis (UF + HD). This difference might be explained by differences in thermal energy balances. In this study we compared the thermal energy balance of i-UF with UF + HD at different dialysate temperatures (Td) and determined the Td at which the thermal energy balance during UF + HD is similar to the thermal energy balance during i-UF.
In the first part of the study, 10 chronic haemodialysis patients were compared during three different treatment sessions, i-UF, UF + HD at Td of 35.5 degrees C and UF + HD at Td of 37.5 degrees C. The second part of the study consisted of one session of 1 h of UF + HD (UF + HD ET-set) with a pre-set energy transfer (ET) at the same level of ET found for that particular patient during i-UF in the first part of the study.
First part of the study: body temperature (BT) decreased significantly during i-UF (-0.25 +/- 0.25 degrees C, P<0.05) and UF + HD 35.5 degrees C (-0.24 +/- 0.18 degrees C, P<0.05) and increased significantly during UF + HD 37.5 degrees C (+0.18 +/- 0.19 degrees C, P<0.05). The differences between the change in BT during UF + HD 37.5 degrees C compared with the other treatments were significant (P<0.05). ET gave a significantly more negative value during i-UF (-30.8 +/- 3.1 W, P<0.05) than during UF + HD 35.5 degrees C (-23.6 +/- 4.1 W, P<0.05). A slightly positive ET was found during UF + HD 37.5 degrees C (+0.4 +/- 4.7 W, P=not significant). Second part of the study: there was a slight, but not significant, decrease in BT during UF + HD ET-set (-0.17 +/- 0.26 degrees C). The changes in BT did not differ significantly between i-UF and UF + HD ET-set. After 1 h of UF + HD ET-set, the mean Td was 34.75 degrees C (34.0-36.0 degrees C). The correlation between pre-dialysis BT and Td during UF + HD ET-set was significant (r=0.764, P<0.05).
ET gives a more negative value during i-UF than during UF + HD 35.5 degrees C and than during UF + HD 37.5 degrees C. To obtain the same thermal ET during UF + HD as that achieved during i-UF, a mean Td of 34.75 degrees C is needed, depending on the pre-dialytic BT of the patient. The results of this study may be of relevance in relation to future clinical investigations which can elucidate whether differences in vascular response between i-UF and UF + HD are only related to differences in thermal balance.
与联合超滤/血液透析（UF + HD）相比，单纯超滤（i - UF）期间血流动力学稳定性维持得更好。这种差异可能由热能平衡的差异来解释。在本研究中，我们比较了不同透析液温度（Td）下i - UF与UF + HD的热能平衡，并确定了UF + HD期间热能平衡与i - UF期间热能平衡相似时的Td。
在研究的第一部分，对10例慢性血液透析患者在三个不同的治疗阶段进行比较，即i - UF、Td为35.5℃的UF + HD以及Td为37.5℃的UF + HD。研究的第二部分包括1小时的UF + HD（UF + HD ET设置），其预设能量转移（ET）与该特定患者在研究第一部分的i - UF期间发现的ET水平相同。
研究的第一部分：i - UF期间体温（BT）显著下降（-0.25±0.25℃，P<0.05），35.5℃的UF + HD期间也显著下降（-0.24±0.18℃，P<0.05），而在37.5℃的UF + HD期间显著升高（+0.18±0.19℃，P<0.05）。37.5℃的UF + HD期间BT变化与其他治疗相比差异显著（P<0.05）。i - UF期间ET的负值显著大于35.5℃的UF + HD期间（-30.8±3.1W，P<0.05）。37.5℃的UF + HD期间发现ET略有正值（+0.4±4.7W，P无统计学意义）。研究的第二部分：UF + HD ET设置期间BT略有下降，但无统计学意义（-0.17±0.26℃）。i - UF与UF + HD ET设置之间BT的变化无显著差异。UF + HD ET设置1小时后，平均Td为34.75℃（34.0 - 36.0℃）。UF + HD ET设置期间透析前BT与Td之间的相关性显著（r = 0.764，P<0.05）。
i - UF期间ET的负值大于35.5℃的UF + HD期间以及37.5℃的UF + HD期间。为了在UF + HD期间获得与i - UF期间相同的热能ET，根据患者透析前的BT，需要平均Td为34.75℃。本研究结果可能与未来的临床研究相关，这些研究可以阐明i - UF与UF + HD之间血管反应的差异是否仅与热平衡的差异有关。
