Ishibe Shuta, Peixoto Aldo J
Section of Nephrology, Yale University School of Medicine, New Haven, USA.
Semin Dial. 2004 Jan-Feb;17(1):37-43. doi: 10.1111/j.1525-139x.2004.17112.x.
Determining dry weight and assessing extracellular fluid volume in hemodialysis (HD) patients is one of the greatest challenges to practicing nephrologists. The clinical examination has limited accuracy, so different strategies have been investigated to aid in this evaluation. Biochemical markers of volume overload (ANP, BNP, cGMP) are fraught with excessive variability and poor correlation with volume status. Inferior vena cava ultrasound is effective, but cumbersome and costly. Bioimpedance measurements of intra- and extracellular water have significant shortcomings when used as isolated measurements, but can be useful in following trends over time and have been shown to improve intradialytic symptoms and blood pressure control. Continuous blood volume monitoring is helpful in preventing intradialytic hypotension and may help identify patients who are volume overloaded and need increased ultrafiltration. In this review we discuss these different techniques and other developments in the evaluation of dry weight and volume status, which may enhance our ability to improve patient stability and well-being during HD sessions.
确定血液透析（HD）患者的干体重并评估细胞外液体积是执业肾病学家面临的最大挑战之一。临床检查的准确性有限，因此人们研究了不同的策略来辅助这一评估。容量超负荷的生化标志物（心钠素、脑钠肽、环磷酸鸟苷）存在过度变异性且与容量状态的相关性较差。下腔静脉超声检查有效，但操作繁琐且成本高昂。细胞内和细胞外水的生物电阻抗测量作为单独测量方法存在显著缺点，但可用于跟踪随时间的变化趋势，并已证明有助于改善透析期间的症状和血压控制。连续血容量监测有助于预防透析期间的低血压，并可能有助于识别容量超负荷且需要增加超滤的患者。在这篇综述中，我们讨论了这些不同的技术以及在干体重和容量状态评估方面的其他进展，这些进展可能会增强我们在血液透析期间改善患者稳定性和健康状况的能力。
