Shirazian Shayan, Rios-Rojas Liliana, Drakakis James, Dikkala Sudharani, Dutka Paula, Duey Marc, Cho Daniel J, Fishbane Steven
Division of Nephrology, Winthrop University Hospital, Mineola, New York, USA.
Hemodial Int. 2012 Jul;16(3):342-50. doi: 10.1111/j.1542-4758.2012.00671.x. Epub 2012 Feb 23.
Increased whole blood viscosity (WBV) can be injurious to the vascular endothelium and increase the risk of atherothrombotic events. This study examined the effect of hemodialysis ultrafiltration (UF) on WBV, with a focus on high vs. low-volume UF patients. In stable hemodialysis patients, blood was drawn for hematocrit (Hct) and WBV at the start, midpoint, and at the end of dialysis. For analysis, patients were divided into high UF (≥2700 mL) or low UF (<2700 mL) groups. A total of 59 patients completed the study. Mean Hct increased during dialysis in both groups. The intradialytic increase in Hct was significantly greater in the high vs. the low UF group (3.2% vs. 1.28%, P = 0.01), with a significantly higher end-dialysis Hct in the high UF group (40.5% vs. 38%, P = 0.02). At the end of dialysis, both high shear rate WBV (P < 0.01) and low shear rate WBV (P < 0.01) were significantly higher in the high UF compared with the low UF group. There was an approximately two-fold greater increase in high shear rate (P < 0.01) and low shear rate (P = 0.01) WBV during dialysis in high vs. low UF groups. The increase in high shear rate WBV during dialysis was significantly correlated with an increase in Hct (R(2) = 0.63, P < 0.01). We found that hemodialysis UF causes a surge in WBV. The surge was of greater magnitude in high than in low UF patients.
全血粘度（WBV）升高可损害血管内皮，并增加动脉粥样硬化血栓形成事件的风险。本研究探讨了血液透析超滤（UF）对WBV的影响，重点关注高容量与低容量UF患者。在稳定的血液透析患者中，于透析开始时、中点和结束时采集血液检测血细胞比容（Hct）和WBV。为进行分析，将患者分为高UF（≥2700 mL）或低UF（<2700 mL）组。共有59例患者完成了研究。两组患者在透析期间Hct均升高。高UF组透析期间Hct的升高显著大于低UF组（3.2%对1.28%，P = 0.01），高UF组透析结束时的Hct显著更高（40.5%对38%，P = 0.02）。透析结束时，高UF组的高切变率WBV（P < 0.01）和低切变率WBV（P < 0.01）均显著高于低UF组。高UF组与低UF组相比，透析期间高切变率（P < 能01）和低切变率（P = 0.01）WBV的升高幅度约大两倍。透析期间高切变率WBV的升高与Hct的升高显著相关（R² = 0.63，P < 0.01）。我们发现血液透析超滤会导致WBV激增。高UF患者的激增幅度大于低UF患者。
