无醋酸盐血液透析滤过（HDF）联合内源性再灌注（HFR）对心肌肌钙蛋白水平的影响。

Effects of acetate-free haemodiafiltration (HDF) with endogenous reinfusion (HFR) on cardiac troponin levels.

机构信息

Territorial Department of Nephrology and Dialysis, ASL 8, Cagliari, Italy.

出版信息

Nephrol Dial Transplant. 2011 Jan;26(1):258-63. doi: 10.1093/ndt/gfq359. Epub 2010 Jul 1.

DOI:10.1093/ndt/gfq359

PMID:20601367

Abstract

BACKGROUND

Haemofiltrate reinfusion (HFR) is a form of haemodiafiltration (HDF) in which replacement fluid is constituted by ultrafiltrate from the patient 'regenerated' through a cartridge containing hydrophobic styrene resin. Bicarbonate-based dialysis solutions (DS) used in routine haemodialysis and HDF contain small quantities of acetate (3-5 mMol/L) as stabilizing agent, one of the major causes of intradialytic hypotension. Acetate-free (AF) DS have recently been made available, substituting acetate with hydrochloric acid. Cardiac troponin (cTnT) constitutes an appreciable marker of myocardial damage and cardiac hypertrophy, and correlates with left ventricular mass.

METHODS

The aim of this study was to assess the impact of the presence or lack of acetate in DS on cTnT levels in patients treated with HFR and to evaluate outcome of intra-session cardiovascular stability. Twenty-five patients devoid of major cardiovascular comorbidity were randomized and treated with AF HFR for 3 months. The same patients were subsequently treated by means of HFR with DS containing 3 mMol/L acetate for 3 months and finally with AF HFR for a further 3 months. Prior and subsequent to each treatment period, samples were collected for cTnT measurement.

RESULTS

A significant decrease was observed in cTnT levels throughout the first session of AF HFR (1.32 ± 0.35-1.12 ± 0.31 ng/mL, P < 0.05) with a subsequent rise being registered during HFR with acetate-containing DS (1.12 ± 0.31-1.28 ± 0.37 ng/mL, P < 0.05) and a further drop from 1.28 ± 0.37 to 1.21 ± 0.35 ng/mL in the last AF HFR period. During HFR with acetate-containing DS, a significant drop in systolic and diastolic arterial pressure was observed in conjunction with a higher heart rate at the end of the session.

CONCLUSION

We observed an increase in cTnT during HFR with acetate and drops manifested during HFR without acetate; it may therefore be concluded that the drop in cTnT level, significantly correlated with lack of acetate, is indicative of improvement of cardiac microvascular function.

摘要

背景

血液滤过再输注（HFR）是血液透析滤过（HDF）的一种形式，其中替代液由通过含有疏水性苯乙烯树脂的盒再生的患者的超滤液构成。常规血液透析和 HDF 中使用的碳酸氢盐透析液（DS）含有少量作为稳定剂的醋酸盐（3-5 mMol/L），这是透析期间低血压的主要原因之一。最近，已经可以获得无醋酸盐（AF）DS，用盐酸代替醋酸盐。心肌肌钙蛋白（cTnT）是心肌损伤和心脏肥大的重要标志物，与左心室质量相关。

方法

本研究旨在评估 DS 中是否存在醋酸盐对接受 HFR 治疗的患者 cTnT 水平的影响，并评估治疗期间心血管稳定性的结果。25 名无重大心血管合并症的患者被随机分为两组，分别接受 3 个月的 AF HFR 治疗。随后，相同的患者接受含有 3 mMol/L 醋酸盐的 DS 的 HFR 治疗 3 个月，然后再接受 AF HFR 治疗 3 个月。在每个治疗期之前和之后，收集样本进行 cTnT 测量。

结果

在 AF HFR 的第一次治疗中，cTnT 水平显著下降（1.32±0.35-1.12±0.31ng/mL，P<0.05），随后在含有醋酸盐的 DS 的 HFR 治疗中观察到升高（1.12±0.31-1.28±0.37ng/mL，P<0.05），在最后一次 AF HFR 期间，cTnT 水平从 1.28±0.37降至 1.21±0.35ng/mL。在含有醋酸盐的 DS 的 HFR 治疗期间，观察到收缩压和舒张压在治疗结束时显著下降，心率升高。