Maduell F, Arias M, Garro J, Vera M, Fontseré M, Barros X, Massó E, Martina M N, Sentis A, Durán C, Bergada E, Cases A, Campistol J M
Servicio de Nefrología, Hospital Clínic, Barcelona, Barcelona.
Nefrologia. 2010;30(3):349-53. doi: 10.3265/Nefrologia.pre2010.Apr.10411.
Post-dilution on-line hemodiafiltration (OL-HDF) is the most efficient infusion mode to obtain maximum clearances of uremic toxins, with a recommended manual infusion flow (Qi) of 25% of the blood flow with the main limitation that causes alarms by hemoconcentration throughout the session. Recent technical advances allow automatic prescription of Qi if hematocrit and total protein (TP) values are specified. As these analytical results are not possible to obtain in each dialysis session, a practical way to prescribe Qi is to make an automatic prescription adjusting the hematocrit and total protein values at the beginning of the session to obtain the manual prescription required and we will call it automatic-manual prescription. The aim of this study was to compare manual Qi with automatic-manual Qi in postdilution OL-HDF. 30 patients (16 men and 14 women), 59.9 +/- 15 years old, in hemodialysis program for 50.1 +/- 67 months were included. Every patient underwent four OL-HDF sessions, two with manual Qi (4008-S and 5008 monitors) and two with automatic-manual Qi (A-M), one with the same Qi and one with manual Qi +20 (A-M+20). The same usual dialysis parameters were maintained: helixone dialyzer, dialysis time of 266 +/- 39 minutes, blood flow of 420 +/- 36. Recirculation, Kt and intradialysis alarms were measured at each session. No significant differences in the fistula recirculation or dialysis dose measured using Kt. Total infusion volume was 24.9 +/- 4 (4008 S), 23.4 +/- 4 L (5008) with manual Qi, 23.6 +/- 4 L (A-M) Qi (NS) and 25.8 +/- 5 L (A-M+20). Only 14% of patients had no incidents. The number of alarms was significantly higher with manual prescription 55 alarms with 4008 and 40 with 5008 vs. AM (11) p < 0.01) and A-M+20 (16 alarms) We concluded that automatic-manual Qi is a practical way for post-dilutional OL-HDF prescription where the same efficiency and total reinfusion volume with an important reduction of intradialysis alarms are obtained, allowing to rise Qi by 20% without increasing intradialysis alarms.
后置稀释在线血液透析滤过（OL-HDF）是获得尿毒症毒素最大清除率的最有效输注模式，推荐的手动输注流量（Qi）为血流量的25%，其主要局限性在于在整个治疗过程中会因血液浓缩引发警报。最近的技术进步使得在指定血细胞比容和总蛋白（TP）值的情况下能够自动设定Qi。由于并非每次透析治疗都能获得这些分析结果，一种设定Qi的实用方法是进行自动设定，在治疗开始时调整血细胞比容和总蛋白值，以获得所需的手动设定值，我们将其称为自动-手动设定。本研究的目的是比较后置稀释OL-HDF中手动Qi与自动-手动Qi。纳入了30例患者（16例男性和14例女性），年龄59.9±15岁，接受血液透析治疗50.1±67个月。每位患者接受四次OL-HDF治疗，两次采用手动Qi（4008-S和5008监护仪），两次采用自动-手动Qi（A-M），一次采用相同的Qi，一次采用手动Qi +20（A-M+20）。维持相同的常规透析参数：使用Helixone透析器，透析时间为266±39分钟，血流量为420±36。每次治疗时测量再循环、Kt和透析过程中的警报情况。在使用Kt测量的内瘘再循环或透析剂量方面无显著差异。手动Qi时的总输注量为24.9±4（4008 S）、23.4±4 L（5008），自动-手动Qi（A-M）时为23.6±4 L（无显著性差异），自动-手动Qi +20时为25.8±5 L。只有14%的患者未发生任何情况。手动设定时的警报数量显著更高，4008监护仪有55次警报，5008监护仪有40次警报，而自动-手动Qi（A-M）为11次（p<0.01），自动-手动Qi +20为16次警报。我们得出结论，自动-手动Qi是后置稀释OL-HDF设定的一种实用方法，可获得相同的效率和总回输量，同时显著减少透析过程中的警报，允许将Qi提高20%而不增加透析过程中的警报。
