Tapolyai Mihály B, Faludi Mária, Fülöp Tibor, Dossabhoy Neville R, Szombathelyi Anita, Berta Klára
Fresenius Medical Care, Semmelweis University, Budapest, Hungary; Department of Medicine, Division of Nephrology, WJB Dorn VA Medical Center, Columbia, South Carolina, USA.
Hemodial Int. 2014 Apr;18(2):384-90. doi: 10.1111/hdi.12125. Epub 2014 Jan 19.
Ultrafiltration (UF) is a common procedure performed during almost all dialysis sessions. During UF, several liters of fluid are removed; however, what proportion of this fluid is removed from which fluid space could not be clinically measured easily until now; we designed this study to evaluate the fluid spaces most affected by UF. This is a prospective cohort study of 40 prevalent chronic hemodialysis patients receiving thrice weekly hemodiafiltration (HDF). We measured the patients' fluid spaces using a whole-body bioimpedance apparatus to evaluate the changes of fluid spaces before and immediately after the HDF sessions. We recorded the data on fluid spaces, UF volume, and blood pressures. The cohort consisted of 40 prevalent HDF patients, aged 60.0 ± 5.2 years (37.5% men; 27.5% people with diabetes), and body weight 71.03 ± 15.48 kg. Achieved UF was 2.38 ± 0.98 L on HDF (measured fluid overload: 2.35 ± 1.44 L). The extracellular fluid (EC) volume decreased from 16.84 ± 3.52 to 14.89 ± 3.06 L (P < 0.0001) and intracellular fluid (IC) volume from 16.88 ± 4.40 to 16.55 ± 4.48 L (P = 0.45). Although urea volume of distribution remained effectively unchanged (31.38 ± 7.28 vs. 30.70 ± 7.32 L; P = 0.45), the degree of EC volume overload decreased from 13.60% ± 7.30% to 3.83% ± 8.32% (P < 0.0001). The mean arterial pressure also decreased from 122.95 ± 19.02 to 108.50 ± 13.91 mmHg (P < 0.0001). We conclude that source of net fluid loss by ultrafiltration is almost exclusively the EC fluid space. The intracellular fluid space is not significantly affected immediately after HDF.
超滤（UF）是几乎所有透析疗程中都会进行的常见操作。在超滤过程中，会移除数升的液体；然而，直到现在，还无法轻易在临床上测量出从哪个体液间隙移除了该液体的多大比例；我们设计了这项研究来评估受超滤影响最大的体液间隙。这是一项针对40例接受每周三次血液透析滤过（HDF）的慢性血液透析患者的前瞻性队列研究。我们使用全身生物电阻抗仪测量患者的体液间隙，以评估血液透析滤过疗程前后体液间隙的变化。我们记录了体液间隙、超滤量和血压的数据。该队列由40例接受血液透析滤过的患者组成，年龄为60.0±5.2岁（37.5%为男性；27.5%患有糖尿病），体重为71.03±15.48千克。血液透析滤过过程中的超滤量为2.38±0.98升（测量的液体超负荷为2.35±1.44升）。细胞外液（EC）体积从16.84±3.52升降至14.89±3.06升（P<0.0001），细胞内液（IC）体积从16.88±4.40升降至16.55±4.48升（P=0.45）。尽管尿素分布容积基本保持不变（31.38±7.28升对30.70±7.32升；P=0.45），但细胞外液体积超负荷程度从13.60%±7.30%降至3.83%±8.32%（P<0.0001）。平均动脉压也从122.95±19.02毫米汞柱降至108.50±13.91毫米汞柱（P<0.0001）。我们得出结论，超滤导致的净液体损失几乎完全来自细胞外液间隙。血液透析滤过疗程后，细胞内液间隙未受到显著影响。
