Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran.
Nefrologia. 2012;32(1):89-93. doi: 10.3265/Nefrologia.pre2011.Nov.10967.
The development of intradialytic hypotension during hemodialysis (HD) in which fluid removal is the primary goal, contributes to the excessive morbidity that is associated with the dialysis procedure.
In a double blinded clinical trial, we compared the possible effect of intranasal DDAVP with intranasal distilled water as a placebo in prevention of intradialytic hypotension (IDH) in patients with known symptomatic IDH. In the first month of the study, nasal spray of distill water were administrated 30 minutes before all HD session (Placebo Group, Group 1) and then after a 30-day washout period we were used intranasal DDAVP 30 minutes before HD session (Vasopressin Group, Group 2). Blood pressure was measured just before HD, two hours later and after termination of HD. A hypotensive episode was defined as a decline of systolic blood pressure of more than 10mm Hg.
In overall Seventeen patients (nine men, eight women; mean age, 47.5 years) with known symptomatic IDH were enrolled in the study. The kind of dialysis membranes, mean of blood flow rate, dialyzate flow rate and ultrafiltration rate were the same in both groups. Each group has 204 HD session (17 * 12). Hypotensive episode occurred 18 times (8.82%) in vasopressin group compared with 125 times (61.27%) in placebo group and there was a significant association between them (p=0.0001). In addition mean arterial blood pressure in vasopressin group was 80.77 and in placebo group was 73.92 and also there was a significant association (p=0.0001). The mean Kt/v in group 1 and 2 were 1.29 and 1.28 without any differences between them (p=0.896).
These results indicate that Compared with placebo, Vasopressin is significantly associated with a decreased incidence of intradialytic hypotension episodes during hemodialysis.
在以清除液体为主要目标的血液透析（HD）过程中发生的透析中低血压会导致与透析过程相关的过度发病率。
在一项双盲临床试验中，我们比较了鼻内给予 DDAVP 与鼻内给予蒸馏水（安慰剂）对已知有症状透析中低血压（IDH）患者预防 IDH 的可能效果。在研究的第一个月中，所有 HD 治疗前 30 分钟给予蒸馏水鼻喷雾（安慰剂组，第 1 组），然后在 30 天洗脱期后，我们在 HD 治疗前 30 分钟给予鼻内 DDAVP（血管加压素组，第 2 组）。在 HD 治疗前、两小时后和 HD 治疗结束时测量血压。低血压发作定义为收缩压下降超过 10mmHg。
共有 17 名（9 名男性，8 名女性；平均年龄 47.5 岁）已知有症状 IDH 的患者参加了这项研究。两种透析膜、平均血流速度、透析液流速和超滤率在两组中均相同。每组有 204 次 HD 治疗（17*12）。血管加压素组发生低血压发作 18 次（8.82%），安慰剂组发生 125 次（61.27%），两者之间存在显著关联（p=0.0001）。此外，血管加压素组的平均动脉血压为 80.77mmHg，安慰剂组为 73.92mmHg，两者之间也存在显著关联（p=0.0001）。第 1 组和第 2 组的平均 Kt/v 分别为 1.29 和 1.28，两者之间无差异（p=0.896）。
与安慰剂相比，血管加压素显著降低血液透析期间透析中低血压发作的发生率。
