Division of Nephrology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.
Blood Purif. 2012;34(3-4):325-31. doi: 10.1159/000345334. Epub 2013 Jan 8.
Although prior studies have shown that frequent hemodialysis (HD) can lead to improved control of dry weight in end-stage renal disease patients, there are no clinical studies examining whether this can improve blood pressure (BP) control and can also shorten the dialysis time needed to achieve satisfactory removal of small molecules. Several models of wearable dialysis systems are now under various stages of development. These devices present the possibility of hemodialyzing patients to their dry weights. We have built a prototype of a wearable ultrafiltration (UF) device that can provide daily UF. Apart from better fluid control, we hypothesize that separating HD from UF will result in better BP control, and adequate weekly small molecule removal could be achieved with a decreased duration of dialysis. We tested the hypothesis in current HD patients using conventional dialysis equipment.
Thirteen patients were selected from a large urban HD center. The experimental period consisted of 4 weeks of daily UF (4 days/week of UF alone and 2 days/week of HD with UF). The duration of the HD sessions was increased by 15-30 min to maintain weekly standard Kt/V >2.0. The patients were then returned to their conventional 3 days/week of HD with UF and studied for 4 weeks. Predialysis BPs, interdialytic weight gains, and Kt/V results of the experimental and return periods were compared with those of the 3-month control period. No changes were made in antihypertensive or other medication during the study.
During the experimental period, mean arterial pressure decreased from 110 to 95 mm Hg (p < 0.001), systolic BP from 158 to 136 mm Hg (p < 0.001), while interdialytic weight gains were reduced from 3.25 to 1.21 liters (p < 0.0001). During the experimental period, weekly standard Kt/V of 2.16 was achieved in 8.24 h/week of HD, as compared to 11.14 h/week.
Volume control with daily UF results in improved BP control and, by separating the UF function from HD, adequate weekly standard Kt/V >2 can be achieved with twice weekly HD.
虽然先前的研究表明频繁的血液透析（HD）可以改善终末期肾病患者干体重的控制，但目前还没有临床研究检查这是否可以改善血压（BP）控制，并且还可以缩短实现小分子令人满意去除所需的透析时间。现在有几种可穿戴透析系统模型处于不同的开发阶段。这些设备提供了将患者透析至干体重的可能性。我们已经构建了一种可穿戴超滤（UF）设备的原型，该设备可以提供日常 UF。除了更好的液体控制之外，我们假设将 HD 与 UF 分开会导致更好的 BP 控制，并且可以通过减少透析时间来实现足够的每周小分子去除。我们使用常规透析设备在当前的 HD 患者中测试了该假设。
从一个大型城市 HD 中心选择了 13 名患者。实验期包括 4 周的每日 UF（每周 4 天 UF 单独，每周 2 天 HD 与 UF）。HD 疗程的持续时间增加了 15-30 分钟，以维持每周标准 Kt/V>2.0。然后，患者返回其常规的每周 3 天 UF 与 HD，并进行了 4 周的研究。比较了实验和返回期的透析前 BP、透析间体重增加和 Kt/V 结果与 3 个月对照期的结果。在研究期间，未改变降压或其他药物。
在实验期间，平均动脉压从 110 降至 95mmHg（p<0.001），收缩压从 158 降至 136mmHg（p<0.001），而透析间体重增加从 3.25 降至 1.21 升（p<0.0001）。在实验期间，每周标准 Kt/V 为 2.16，每周需要进行 8.24 小时的 HD，而每周需要进行 11.14 小时的 HD。
每日 UF 的容量控制可改善 BP 控制，并且通过将 UF 功能与 HD 分离，可以每周进行两次 HD 即可达到足够的每周标准 Kt/V>2。
