Rodriguez Hector J, Domenici Regina, Diroll Anne, Goykhman Irina
Department of Medicine, Division of Nephrology, Cedars-Sinai, Medical Center, UCLA School of Medicine, Los Angeles, California, USA.
Kidney Int. 2005 Aug;68(2):854-61. doi: 10.1111/j.1523-1755.2005.00467.x.
Routine assessment of dry weight in chronic hemodialysis patients relies primarily on clinical evaluation of patient fluid status. We evaluated whether measurement of postdialytic vascular refill could assist in the assessment of dry weight.
Twenty-eight chronic, stable hemodialysis patients were studied during routine treatment sessions using constant dialysate temperature and dialysate sodium concentration, and relative changes in blood volume were monitored using Crit-Line III monitors throughout this study. The study was divided into three phases. Phase 1 studies evaluated the time-dependence of vascular compartment refill after completion of hemodialysis. Phase 2 studies evaluated the relationships in patient subgroups between intradialytic changes in blood volume and the presence of postdialytic vascular compartment refill during that last 10 minutes of hemodialysis after stopping ultrafiltration. Phase 3 studies evaluated the extent of dry weight changes following the application of a protocol for blood volume reduction, postdialytic vascular compartment refill, and correlation with clinical evidence of intradialytic hypovolemia and/or postdialytic fatigue. Phase 3 included anywhere from three to five treatments.
Phase 1 studies demonstrated that despite interpatient variability in the magnitude of postdialytic vascular compartment refill, when significant refill was evident, it always continued for at least 30 minutes. However, the majority of refill took place within 10 minutes postdialysis. Phase 2 studies identified 3 groups of patients: those who exhibited intradialytic reductions in blood volume but not postdialytic vascular compartment refill (group 1), those who exhibited intradialytic reductions in blood volume and postdialytic vascular compartment refill (group 2), and those whose blood volume did not change substantially during hemodialysis treatment (group 3). In phase 3 studies, use of an ultrafiltration protocol for blood volume reduction and monitoring of postdialytic vascular compartment refill combined with clinical assessment of hypovolemia and postdialytic fatigue demonstrated that patients often had a clinical dry weight assessment which was too low or too high. In all 28 patients studied, dry weight was either increased or decreased following use of this protocol.
Determination of the extent of both intradialytic decreases in blood volume and postdialytic vascular compartment refill, combined with clinical assessment of intradialytic hypovolemia and postdialytic fatigue, can help assess patient dry weight and optimize volume status while reducing dialysis associated morbidity. The number of hospital admissions due to fluid overload may be reduced.
慢性血液透析患者干体重的常规评估主要依赖于对患者液体状态的临床评估。我们评估了透析后血管再充盈的测量是否有助于干体重的评估。
在常规治疗期间，对28例慢性稳定血液透析患者进行研究，透析液温度和透析液钠浓度保持恒定，并在整个研究过程中使用Crit-Line III监测仪监测血容量的相对变化。该研究分为三个阶段。第一阶段研究评估血液透析结束后血管腔再充盈的时间依赖性。第二阶段研究评估了患者亚组中透析期间血容量变化与停止超滤后血液透析最后10分钟内透析后血管腔再充盈之间的关系。第三阶段研究评估了应用血容量减少方案、透析后血管腔再充盈以及与透析期间血容量不足和/或透析后疲劳的临床证据的相关性后干体重变化的程度。第三阶段包括三到五次治疗。
第一阶段研究表明，尽管透析后血管腔再充盈程度存在个体差异，但当明显出现显著再充盈时，其总是持续至少30分钟。然而，大多数再充盈发生在透析后10分钟内。第二阶段研究确定了3组患者：透析期间血容量减少但透析后血管腔未再充盈的患者（第1组）、透析期间血容量减少且透析后血管腔再充盈的患者（第2组）以及血液透析治疗期间血容量无显著变化的患者（第3组）。在第三阶段研究中，使用超滤方案减少血容量并监测透析后血管腔再充盈，同时结合对血容量不足和透析后疲劳的临床评估，结果表明患者的临床干体重评估往往过高或过低。在所有28例研究患者中，使用该方案后干体重均有增加或减少。
确定透析期间血容量减少的程度和透析后血管腔再充盈的程度，同时结合对透析期间血容量不足和透析后疲劳的临床评估，有助于评估患者的干体重并优化容量状态，同时降低与透析相关的发病率。因液体过载导致的住院次数可能会减少。
