Basile Carlo, Libutti Pasquale, Lisi Piero, Rossi Luigi, Lomonte Carlo
Division of Nephrology, Miulli General Hospital, 70021, Acquaviva delle Fonti, Italy,
J Nephrol. 2015 Aug;28(4):517-20. doi: 10.1007/s40620-014-0159-8. Epub 2014 Dec 6.
Probing dry weight (DW) was largely dependent on clinical subjective estimate until recently. New bedside non-invasive tools have been developed with the aim of providing more objective information on volume status and guiding physicians in the quest for DW. Among them, bioimpedance appears to be very promising in the achievement of this goal. We have developed a test aimed to assess DW in complicated hemodialysis (HD) patients and named it "RE.sistance S.tabilization T.est" (RE.S.T.). It is based on the following four items: 1. one or more HD sessions lasting 6 h with ultrafiltration (UF) rate ≤0.5 kg/h are planned; 2. bioimpedance measurements are determined injecting 800 μA at 50 kHz alternating sinusoidal current with a standard tetrapolar technique. Resistance (R) is recorded at the start of the treatment (R0) and every 15 min (Rt) during HD until the end of the 6-h session; 3. DW is defined as that achieved at the time point at which three consecutive R0/Rt ratios show in-between changes ±1% despite ongoing UF; 4. if at the end of the 6-h HD session R stabilization is not attained, a new 6-h HD treatment with UF rate ≤0.5 kg/h is planned until a bioimpedance DW (according to the item 3) is obtained. As said, we are applying RE.S.T. to assess DW in complicated HD patients. Here we report a paradigmatic case which illustrates quite brilliantly its clinical usefulness. The patient was admitted to our nephrology ward with a hypertensive crisis, a very large drug regimen notwithstanding. His DW was reduced by 5 kg after four 6-h HD sessions probing his DW by means of RE.S.T. He was discharged with a normal blood pressure and no need for anti-hypertensive drugs. In conclusion, RE.S.T. appears to be a (the) brilliant solution in solving the old problem of DW in HD patients.
直到最近，探测干体重（DW）在很大程度上仍依赖于临床主观估计。新型床旁非侵入性工具已被开发出来，旨在提供关于容量状态的更客观信息，并在探寻干体重方面为医生提供指导。其中，生物电阻抗在实现这一目标方面似乎非常有前景。我们开发了一项用于评估复杂血液透析（HD）患者干体重的测试，并将其命名为“RE.sistance S.tabilization T.est”（RE.S.T.）。它基于以下四项：1. 计划进行一次或多次持续6小时且超滤（UF）率≤0.5 kg/h的血液透析治疗；2. 使用标准四极技术，以50 kHz的交变正弦电流注入800 μA来测定生物电阻抗。在治疗开始时（R0）以及血液透析期间每15分钟（Rt）记录电阻，直至6小时治疗结束；3. 干体重定义为在连续三个R0/Rt比值显示变化在±1%以内（尽管正在进行超滤）的时间点所达到的体重；4. 如果在6小时血液透析治疗结束时未实现电阻稳定，则计划进行一次新的超滤率≤0.5 kg/h的6小时血液透析治疗，直至获得生物电阻抗法测定的干体重（根据第3项）。如前所述，我们正在应用RE.S.T.来评估复杂血液透析患者的干体重。在此，我们报告一个典型病例，该病例出色地展示了其临床实用性。尽管患者有非常复杂的用药方案，但因高血压危象入住我们的肾脏病病房。通过RE.S.T.对其进行了四次6小时血液透析治疗以探测干体重后，其干体重减轻了5 kg。他出院时血压正常，无需服用降压药。总之，RE.S.T.似乎是解决血液透析患者干体重这一老问题的绝佳方案。
