Ramos R, Soto C, Mestres R, Jara J, Zequera H, Merello J I, Moreso F
Hospital Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, Espana.
Nefrologia. 2007;27(6):737-41.
Symptomatic hypotension is the most frequent acute complication affecting patients during chronic hemodialysis treatment sessions. Many reports have demonstrated that the use of cool dialysate has a protective effect on blood pressure during hemodialysis treatments. In the present study, we investigated whether preventing the hyperthermic response had favourable effects on hemodynamic stability during the hemodialysis procedure while affording good tolerance to patients.
We investigated the effect of thermal control of dialysate on hemodynamic stability in hypotension-prone patients in our center. Patients were eligible for the study if they had symptomatic hypotensive episodes (> 3/12session/ month) during the screening phase. The study was designed with two phases for the same selected patients and two treatment arms, each phase lasting 4 weeks. In the first phase, we adjusted dialysate temperature on 36 masculineC for 12 sessions (cold dialysis) and in the second phase we used a device allowing the regulation of thermal balance (Blood Temperature Monitor; Fresenius Medical Care, Bad Homberg, Germany), that keep body temperature unchanged (isothermic dialysis).
Nine HD patients were enrolled and completed the study. During the screening phase the mean ultrafiltration was 4 1% of dry weight, and blood pressure decreased from 9916 to 8016 mm Hg (p<0.001). In 5.01.7 sessions of 12 treatments were complicated by hypotension. In the first and second phase we observed a decrease of complicated treatments with symptomatic hypotension (5.01.7 versus 2.71.6 y 2.81.7; p<0.01). Both procedures: Cold dialysis and Isothermic dialysis was well tolerated by patients.
Results show that active control of body temperature can significantly improve intradialytic tolerance in hypotension-prone patients.
症状性低血压是慢性血液透析治疗期间影响患者的最常见急性并发症。许多报告表明，使用低温透析液对血液透析治疗期间的血压具有保护作用。在本研究中，我们调查了在血液透析过程中预防热反应是否对血流动力学稳定性有有利影响，同时使患者具有良好的耐受性。
我们在本中心研究了透析液温度控制对易发生低血压患者血流动力学稳定性的影响。如果患者在筛查阶段出现症状性低血压发作（>3/12次治疗/月），则符合研究条件。针对同一组选定患者设计了两个阶段和两个治疗组，每个阶段持续4周。在第一阶段，我们将透析液温度调整为36℃进行12次治疗（冷透析），在第二阶段，我们使用一种允许调节热平衡的设备（血液温度监测仪；德国费森尤斯医疗护理公司，巴特洪堡），使体温保持不变（等温透析）。
9名血液透析患者入组并完成了研究。在筛查阶段，平均超滤量为干体重的4.1%，血压从99±16 mmHg降至80±16 mmHg（p<0.001）。12次治疗中有5.0±1.7次出现低血压并发症。在第一阶段和第二阶段，我们观察到症状性低血压的并发症治疗次数减少（5.0±1.7次对2.7±1.6次和2.8±1.7次；p<0.01）。冷透析和等温透析这两种方法患者耐受性都良好。
结果表明，主动控制体温可显著提高易发生低血压患者的透析耐受性。
