Service de Néphrologie et de Dialyse, Hôpital Privé Claude Galien, 20 route de Boussy, 91480 Quincy sous Sénart, France.
BMC Nephrol. 2011 Oct 20;12:58. doi: 10.1186/1471-2369-12-58.
Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis. Therapeutic albumin has powerful anti-oxidant and anti-inflammatory properties. We have recently shown that systematic colloid infusion during hemodialysis sessions improves hemodynamic parameters in most dialysis hypotension-prone patients unresponsive to usual of preventive measures.We postulated that frequent hypotensive episodes may lead to a noxious inflammatory response mediated by oxidative stress induced by ischemia-reperfusion. The aim of this study was therefore to analyze the effect of 20% albumin and 4% gelatin infusions on oxidative stress and microinflammatory status in hypotension-prone patients unresponsive to usual preventive measures.
Prospective cross-over study (lasting 20 weeks) of routine infusion of 200 ml of 20% albumin versus 200 ml of 4% gelatin in 10 patients with refractory intradialytic hypotension. We analyzed the effect of 20% albumin and 4% gelatin on microinflammatory status, oxidative stress, serum nitrite and nitrate levels by analysis of variance.
A significant decrease in serum ceruloplasmin and serum C3 was observed during the albumin period (p < 0.05, repeated measure ANOVA). A significant decrease in serum hydrogen peroxide was seen during albumin and gelatin administration (p < 0.01, repeated measure ANOVA) and a very large decrease in serum lipid peroxides was observed during the albumin period only (p < 0.01, Friedman test). Serum lactoferrin, serum proinflammatory cytokines and serum nitrite and nitrate levels remained stable during the different periods of this pilot trial.
We conclude that the improvement in microinflammatory status observed during colloid infusion in hypotension-prone dialysis patients may be related to a decrease in ischemia-reperfusion of noble organs, together with a specific reduction in oxidative stress by albumin.
ISRCTN 20957055.
透析中低血压可能会对慢性血液透析的结果产生不利影响。治疗用白蛋白具有强大的抗氧化和抗炎特性。我们最近的研究表明，在血液透析过程中系统性胶体输注可以改善大多数对常规预防措施无反应的透析低血压易患患者的血液动力学参数。我们推测，频繁的低血压发作可能会导致由缺血再灌注引起的氧化应激介导的有害炎症反应。因此，本研究旨在分析 20%白蛋白和 4%明胶输注对常规预防措施无反应的低血压易患患者的氧化应激和微炎症状态的影响。
前瞻性交叉研究（持续 20 周），在 10 例难治性透析中低血压患者中常规输注 200ml 20%白蛋白与 200ml 4%明胶。通过方差分析分析了 20%白蛋白和 4%明胶对微炎症状态、氧化应激、血清硝酸盐和亚硝酸盐水平的影响。
在白蛋白期间观察到血清铜蓝蛋白和血清 C3 显著降低（p < 0.05，重复测量方差分析）。白蛋白和明胶给药期间观察到血清过氧化氢显著降低（p < 0.01，重复测量方差分析），仅在白蛋白期间观察到血清脂质过氧化物显著降低（p < 0.01，弗里德曼检验）。血清乳铁蛋白、血清促炎细胞因子以及血清硝酸盐和亚硝酸盐水平在试验的不同时期保持稳定。
我们得出结论，在透析低血压易患患者中胶体输注观察到的微炎症状态改善可能与贵重器官的缺血再灌注减少有关，同时白蛋白特异性降低氧化应激。
ISRCTN20957055。
