Álvares Valeria R C, Ramos Camila D, Pereira Benedito J, Pinto Ana Lucia, Moysés Rosa M A, Gualano Bruno, Elias Rosilene M
Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
Am J Nephrol. 2017;45(5):409-416. doi: 10.1159/000471513. Epub 2017 Apr 14.
Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer.
We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) ≥20 mm Hg.
There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone.
Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal.
传统血液透析（HD）与透析诱导的低血压（DIH）以及磷酸盐清除效果不佳有关。由于HD期间清除的细胞外液的主要来源是腿部，我们试图通过使用循环和气压式压迫来减少DIH并增加磷酸盐清除，这可能会提供更高的静脉回流，维持中心血流，并且还能为透析器提供更多磷酸盐。
我们以随机交叉方式评估了21例患者，每位患者接受3种不同的HD：对照；在前60分钟进行循环运动；在前60分钟进行气压式压迫。获得的数据包括生物电阻抗、每小时血压测量、生化参数以及通过透析液对磷酸盐的直接定量。DIH定义为平均动脉压（MAP）下降≥20mmHg。
对照、循环运动和气压式压迫之间的超滤率（p = 0.628）、体重变化量（p = 0.415）、总体液、细胞内液和细胞外液变化量（分别为p = 0.209、p = 0.348和p = 0.467）无差异。与对照、循环运动相比，气压式压迫时MAP变化量分别减少（-4.7 [-17.2, 8.2]、-4.7 [-20.5, -0.2]和-2.3 [-8.1, 9.0] mmHg；p = 0.021）。DIH分别发生在对照、循环运动和气压式压迫组的43%、38%和24%的患者中（p = 0.014）。任何干预措施均未使磷酸盐清除增加（p = 0.486）。更高的磷酸盐清除取决于超滤、透析前血清磷酸盐以及更高的甲状旁腺激素。
透析第一小时进行气压式压迫与较少的DIH相关，尽管对液体参数无影响。运动和气压式压迫均未增加磷酸盐清除。
