Power Albert, Charitaki Evangelia, Davenport Andrew
Richard Bright Renal Service, Southmead Hospital, North Bristol NHS Trust, Bristol - UK.
UCL Centre for Nephrology, Royal Free Hospital, London - UK.
Int J Artif Organs. 2016 Jul 4;39(5):228-34. doi: 10.5301/ijao.5000503. Epub 2016 Jun 8.
Haemodiafiltration (HDF) has been reported to cause less hypotension than haemodialysis (HD). We hypothesized that HDF causes less change in vascular tone, thereby reducing hypotension.
Aortic pulse wave velocity (PWVao) was measured in 284 patients, during a single dialysis session using cooled dialysate (117 HD, 177 HDF). Patient groups were matched for age, sex and cardiovascular comorbidity.
Systolic blood pressure (SBP) declined from 144 ± 26 to 133 ± 26 after 20 minutes, and to 131 ± 26 mmHg post HD, and for HDF from 152 ± 26 to 143 ± 27 after 20 minutes, then to 138 ± 27 mmHg post HDF. Net Ultrafiltration rates to achieve weight loss were similar; HD 0.13 ± 0.06 vs HDF 0.12 ± 0.05 mL/kg/min. PWVao did not change after 20 minutes HD 0.42(-0.7 to 1.3), HDF 0.5 (-0.6 to 1.8) or at the end of the session: HD -0.39 (1.5 to 1.2), HDF -0.41(-2.0 to 1.3) m/s. Aortic augmentation index (AiAxo), assessment of vascular tone fell significantly with both HD; 20 minutes by 6.2 (-2.5 to 14), end 5.6 (-6.7 to 13.9), and HDF 20 min by 4.2 (-2.5 to 10), end 7.8 (-0.8 to 19.3), with no difference between HD and HDF. The ultrafiltration rate correlated with % change in aortic SBP (r = 0.28 p = 0.004), but not with changes in PWVao or augmentation indices.
Blood pressure declined during both HD and HDF treatments, as did augmentation indices, unrelated to weight loss, suggesting a reduction in vascular stiffness occurs independently of treatment modality. We did not observe an advantage for HDF.
据报道，血液透析滤过（HDF）引起的低血压比血液透析（HD）少。我们推测，HDF引起的血管张力变化较小，从而减少了低血压的发生。
在284例患者的单次透析过程中，使用低温透析液测量主动脉脉搏波速度（PWVao）（117例HD，177例HDF）。患者组在年龄、性别和心血管合并症方面进行了匹配。
收缩压（SBP）在20分钟后从144±26降至133±26，HD后降至131±26 mmHg，HDF在20分钟后从152±26降至143±27，然后在HDF后降至138±27 mmHg。达到体重减轻的净超滤率相似；HD为0.13±0.06，HDF为0.12±0.05 mL/kg/min。HD 0.42（-0.7至1.3）、HDF 0.5（-0.6至1.8）20分钟后或透析结束时PWVao均未改变：HD为-0.39（1.5至1.2），HDF为-0.41（-2.0至1.3）m/s。两种HD治疗的主动脉增强指数（AiAxo），即血管张力评估均显著下降；20分钟时下降6.2（-2.5至14），结束时下降5.6（-6.7至13.9），HDF 20分钟时下降4.2（-2.5至10），结束时下降7.8（-0.8至19.3），HD和HDF之间无差异。超滤率与主动脉SBP的变化百分比相关（r = 0.28，p = 0.004），但与PWVao或增强指数的变化无关。
HD和HDF治疗期间血压均下降，增强指数也下降，且与体重减轻无关，这表明血管僵硬度的降低与治疗方式无关。我们未观察到HDF有优势。
