Gabrielli Danila, Krystal Batya, Katzarski Krassimir, Youssef Maan, Hachache Toufic, Lopot Frantisek, Lasseur Catherine, Gunne Thomas, Draganov Branimir, Wojke Ralf, Gauly Adelheid
Hospital of Valle d'Aosta, Aosta, Italy.
J Nephrol. 2009 Mar-Apr;22(2):232-40.
Intradialytic morbid events (IMEs) during haemodialysis (HD), including symptomatic hypotension, are related to ultrafiltration (UF)-induced hypovolaemia. Blood volume monitoring and automatic feedback control of the UF rate were developed to limit the extent of hypovolaemia during dialysis. The present study investigated the effect of blood volume (BV)-controlled UF on the incidence of HD treatments with IMEs.
This prospective randomised crossover study included hypotension-prone patients, characterised by occurrence of IMEs in at least 33% of HD treatments during a 6-week screening phase. These patients underwent 2 treatment phases, each lasting 6 weeks, in randomised order. Each patient served as their own control, treated with standard HD in one phase and with BV-controlled UF in the other phase.
Thirty-four patients from 9 HD centres were enrolled; 26 could be included in the analysis population. In comparison with standard HD, BV-controlled UF reduced the percentage of HD sessions complicated by IME significantly from 40%+/-27% to 32%+/-25% (p=0.02). A lower frequency of HD sessions with IME could be observed in 46% of the patients. The frequency of treatments with symptomatic hypotension was reduced from 32%+/-23% in standard HD to 24%+/-21% with BV-controlled UF (p=0.04). Changes in blood pressure and heart rate from start to end of the HD session were not different between the 2 treatment modes.
This crossover study showed improved intradialytic stability with BV-controlled UF, compared with standard HD.
血液透析（HD）过程中的透析期不良事件（IME），包括症状性低血压，与超滤（UF）引起的血容量减少有关。开发了血容量监测和超滤率自动反馈控制，以限制透析期间血容量减少的程度。本研究调查了血容量（BV）控制的超滤对发生IME的HD治疗发生率的影响。
这项前瞻性随机交叉研究纳入了易发生低血压的患者，其特征是在6周的筛查期内至少33%的HD治疗中发生IME。这些患者随机接受2个治疗阶段，每个阶段持续6周。每位患者均作为自身对照，在一个阶段接受标准HD治疗，在另一个阶段接受BV控制的超滤治疗。
来自9个HD中心的34例患者入组；26例可纳入分析人群。与标准HD相比，BV控制的超滤使并发IME的HD治疗百分比从40%±27%显著降低至32%±25%（p=0.02）。46%的患者出现IME的HD治疗频率较低。症状性低血压治疗频率从标准HD的32%±23%降至BV控制的超滤的24%±21%（p=0.04）。两种治疗模式下HD治疗开始至结束时的血压和心率变化无差异。
这项交叉研究表明，与标准HD相比，BV控制的超滤改善了透析期稳定性。
