Division of Nephrology and Dialysis, Centre Hospitalier Privé Claude Galien, Quincy Sous Senart, France.
J Nephrol. 2011 Mar-Apr;24(2):208-17. doi: 10.5301/jn.2011.6367.
Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis. The aim of this study was to assess the effects of routine infusion of 20% albumin and 4% gelatin in dialysis hypotension-prone patients unresponsive to prevention measures.
This was a prospective crossover study (lasting 20 weeks) of routine infusion of 200 mL of these colloids in 10 patients. We analyzed the effect of these colloids by n-of-1 trial methodology (Wilcoxon test) and analysis of variance.
Twenty percent albumin increased systolic blood pressure (SBP) in 6 patients (p<0.05), whereas 4% gelatin improved SBP in only 2 patients (p<0.05). Albumin infusions increased diastolic blood pressure (DBP) in 4 patients (p<0.05), whereas gelatin improved DBP in only 1 patient (p<0.05). Weight gain between dialysis sessions was generally similar during the periods in most patients. An increase in the ultrafiltration rate was observed in 4 of the 6 patients whose blood pressure was improved by colloids (p<0.005). Kt/V and the fall in relative blood volume remained stable during the study, whereas ionic dialysance at the end of the dialysis sessions was improved only by albumin infusion (p<0.05, repeated measures ANOVA).
Systematic colloids infusion during hemodialysis sessions improves hemodynamic parameters in most dialysis hypotension-prone patients unresponsive to usual measures of prevention. Prospective controlled trials are warranted to confirm these preliminary results.
透析中低血压可能对慢性血液透析患者的预后产生不利影响。本研究旨在评估在常规透析中输注 20%白蛋白和 4%明胶对常规预防措施无效的透析低血压倾向患者的影响。
这是一项前瞻性交叉研究（持续 20 周），对 10 例患者常规输注 200ml 胶体。我们采用 n-of-1 试验方法（Wilcoxon 检验）和方差分析来分析这些胶体的效果。
20%白蛋白可使 6 例患者的收缩压（SBP）升高（p<0.05），而 4%明胶仅使 2 例患者的 SBP升高（p<0.05）。白蛋白输注使 4 例患者的舒张压（DBP）升高（p<0.05），而明胶仅使 1 例患者的 DBP升高（p<0.05）。在大多数患者中，透析间期的体重增加通常相似。在血压得到胶体改善的 6 例患者中，有 4 例超滤率增加（p<0.005）。在研究期间，Kt/V 和相对血容量下降保持稳定，而仅白蛋白输注可改善透析结束时的离子透析率（p<0.05，重复测量方差分析）。
在血液透析过程中系统性输注胶体可改善大多数对常规预防措施无效的透析低血压倾向患者的血液动力学参数。需要进行前瞻性对照试验来证实这些初步结果。
