McIntyre C W, Lambie S H, Fluck R J
Department of Renal Medicine, Derby City General Hospital, Derby, UK.
Clin Nephrol. 2003 Aug;60(2):105-12. doi: 10.5414/cnp60105.
It is now possible to link relative blood volume (RBV) measurements to a software loop designed to actuate a biofeedback response. This allows changes in RBV to determine constant alterations in both ultrafiltration rate and dialysate conductivity. RBV, plasma sodium and weight loss are driven throughout the treatment to achieve the best compromise. This system has been demonstrated to markedly reduce intradialytic hypotension in unstable patients. We have applied this treatment to stable, non-hypotension prone HD patients and report on the short-term outcomes.
We prospectively studied all 15 patients in a dedicated 4-station minimal care treatment area. Patients were studied for 3 weeks of standard HD, to understand the morphology and response to RBV in that individual. BF-HD was then instituted for a similar period (after a 2-week optimization period). Dialysis adequacy was assessed with equilibrated Kt/V measurements and urea mass removed in spent dialysate.
We studied 263 treatment sessions. There was a reduction in symptomatic episodes (per patient over 3 weeks) from 3 +/- 0.5 (0-9) to 0.13 +/- 0.13 (0-2) with BF-HD, p < 0.001. Reductions in systolic BP > 40% fell from 1.4 +/- 0.4 (0-4) to 0.46 +/- 0.16 (0-2). Episodes of RBV falling > 10% fell from 6.3 +/- 0.85 (1-13) to 1.13 +/- 0.27 (0-4) with BF-HD, p < 0.001. Interdialytic weight gains fell from 2.08 +/- 0.05 (0.35-3.8) kg to 1.82 +/- 0.06 (0-3.7) kg, p = 0.009. Equilibrated Kt/V increased from 1.01 +/- 0.03 (0.61-1.35) to 1.13 +/- 0.03 (0.7-1.5), p = 0.01, and mass removed of urea increased from 24.9 +/- 3 (12.8-45) g to 32.7 +/- 1.9 (17.3-48.5) g.
This is the first report of BF-HD increasing tolerability, reducing interdialytic fluid gains and enhancing urea clearance in non-hypotension prone chronic HD patients. These data suggest that the previously reported associated benefits of BF-HD may be applicable to the majority of HD patients.
现在可以将相对血容量（RBV）测量与旨在触发生物反馈反应的软件回路相连接。这使得RBV的变化能够决定超滤率和透析液电导率的持续改变。在整个治疗过程中，RBV、血浆钠和体重减轻相互关联，以实现最佳平衡。该系统已被证明能显著降低不稳定患者的透析中低血压。我们已将这种治疗方法应用于稳定的、不易发生低血压的血液透析（HD）患者，并报告其短期结果。
我们对一个专门的4站式最小护理治疗区域内的所有15名患者进行了前瞻性研究。对患者进行3周的标准HD治疗，以了解个体的RBV形态和反应。然后在经过2周的优化期后，进行为期相似的生物反馈辅助血液透析（BF-HD）治疗。通过平衡的Kt/V测量和透析废液中清除的尿素量来评估透析充分性。
我们研究了263个治疗疗程。BF-HD治疗后，症状发作次数（每位患者3周内）从3±0.5（0 - 9）降至0.13±0.13（0 - 2），p < 0.001。收缩压下降>40%的次数从1.4±0.4（0 - 4）降至0.46±0.16（0 - 2）。RBV下降>10%的次数从6.3±0.85（1 - 13）降至1.13±0.27（0 - 4），p < 0.001。透析间期体重增加从2.08±0.05（0.35 - 3.8）kg降至1.82±0.06（0 - 3.7）kg，p = 0.009。平衡的Kt/V从1.01±0.03（0.61 - 1.35）增加到1.13±0.03（0.7 - 1.5），p = 0.01，尿素清除量从24.9±3（12.8 - 45）g增加到32.7±1.9（17.3 - 48.5）g。
这是关于BF-HD提高不易发生低血压的慢性HD患者耐受性、减少透析间期液体增加并增强尿素清除率的首份报告。这些数据表明，先前报道的BF-HD的相关益处可能适用于大多数HD患者。
