Raimann Jochen G, Chan Christopher T, Daugirdas John T, Depner Tom, Gotch Frank A, Greene Tom, Kaysen George A, Kliger Alan S, Kotanko Peter, Larive Brett, Lindsay Robert, Rocco Michael V, Chertow Glenn M, Levin Nathan W
Renal Research Institute, New York, N.Y., USA.
Blood Purif. 2016;41(4):277-86. doi: 10.1159/000441966. Epub 2016 Jan 21.
In previous reports of the Frequent Hemodialysis Network trials, frequent hemodialysis (HD) reduced extracellular fluid (ECF) and left ventricular mass (LVM), with more pronounced effects observed among patients with low urine volume (UVol). We analyzed the effect of frequent HD on interdialytic weight gain (IDWG) and a time-integrated estimate of ECF load (TIFL). We also explored whether volume and sodium loading contributed to the change in LVM over the study period. Treatment effects on volume parameters were analyzed for modification by UVol and the dialysate-to-serum sodium gradient. Predictors of change in LVM were determined using linear regression. Frequent HD reduced IDWG and TIFL in the Daily Trial. Among patients with UVol <100 ml/day, reduction in TIFL was associated with LVM reduction. This suggests that achievement of better volume control could attenuate changes in LVM associated with mortality and cardiovascular morbidity. TIFL may prove more useful than IDWG alone in guiding HD practice. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=441966.
在频繁血液透析网络试验的既往报告中，频繁血液透析（HD）可减少细胞外液（ECF）和左心室质量（LVM），在低尿量（UVol）患者中观察到的效果更为显著。我们分析了频繁HD对透析间期体重增加（IDWG）和ECF负荷的时间积分估计值（TIFL）的影响。我们还探讨了在研究期间，容量和钠负荷是否对LVM的变化有影响。分析了治疗对容量参数的影响是否因UVol和透析液与血清钠梯度而改变。使用线性回归确定LVM变化的预测因素。在每日试验中，频繁HD降低了IDWG和TIFL。在UVol<100 ml/天的患者中，TIFL的降低与LVM的降低相关。这表明实现更好的容量控制可减轻与死亡率和心血管疾病发病率相关的LVM变化。在指导HD实践方面，TIFL可能比单独的IDWG更有用。视频期刊俱乐部“与克劳迪奥·罗恩科一起品尝卡布奇诺”，网址为http://www.karger.com/?doi=441966。
