Ribitsch Werner, Stockinger Jakob, Schneditz Daniel
Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Austria.
Clin Nephrol. 2012 May;77(5):376-82. doi: 10.5414/cn107078.
To compare volume overload in stable hemodialysis (HD) patients assessed by standard clinical judgment with data obtained from bioimpedance analysis.
Ultrafiltration volume (VU) was delivered as prescribed by standard clinical practice. Independently, a measure for volume overload was assessed by a clinical score (SW). The Body Composition Monitor (BCM, Fresenius Medical Care, Bad Homburg, Germany) was used to derive values for extracellular volume (VE) and volume overload (VO) before HD. Arterial pressures (P0, P1) and serum levels of NT-pro-BNP (B0, B1) were evaluated before and after HD.
In 28 patients (11 women, age: 51.3 ± 13.3 y, body mass index (BMI) 18.5 - 40.9 kg/m2; VE: 17.91 ± 3.45 l) delivered VU was 2.41 ± 1.03 l and not different from VO of 2.08 ± 1.49 l derived from bioimpedance analysis. There was no correlation between VO and VU (r = -0.15, p = 0.46) but a negative correlation between the difference VO - VU (i.e., the volume overload at treatment end) and BMI (r = -0.49, p < 0.01). Positive correlations were observed between B0 and the relative volume overload (= VO/VE) (r = 0.58, p < 0.001).
The well recognized relationship between cardiac natriuretic peptides and volume expansion was confirmed. The volume overload at treatment end (VO - VU) was negligible for the whole group of patients but more negative with increasing BMI. It therefore appears that in comparison to bioimpedance-based evaluation the clinical judgment overestimates volume overload in obese patients which leads to the delivery of high ultrafiltration volumes and to volume contraction at the end of a dialysis session in this group of patients.
比较通过标准临床判断评估的稳定血液透析（HD）患者的容量超负荷情况与生物电阻抗分析获得的数据。
按照标准临床实践规定输送超滤量（VU）。独立地，通过临床评分（SW）评估容量超负荷情况。使用人体成分监测仪（BCM，德国巴德洪堡费森尤斯医疗护理公司）在HD前得出细胞外液量（VE）和容量超负荷（VO）的值。在HD前后评估动脉压（P0、P1）和NT - 脑钠肽的血清水平（B0、B1）。
在28例患者中（11名女性，年龄：51.3±13.3岁，体重指数（BMI）18.5 - 40.9kg/m²；VE：17.91±3.45升），输送的VU为2.41±1.03升，与生物电阻抗分析得出的VO为2.08±1.49升无差异。VO与VU之间无相关性（r = -0.15，p = 0.46），但VO - VU差值（即治疗结束时的容量超负荷）与BMI之间呈负相关（r = -0.49，p < 0.01）。观察到B0与相对容量超负荷（= VO/VE）之间呈正相关（r = 0.58，p < 0.001）。
证实了心脏利钠肽与容量扩张之间公认的关系。治疗结束时的容量超负荷（VO - VU）在整个患者组中可忽略不计，但随着BMI增加更呈负值。因此，与基于生物电阻抗的评估相比，临床判断似乎高估了肥胖患者的容量超负荷，这导致在该组患者的透析 session 结束时输送高超滤量并导致容量收缩。
