Torterüe Xavier, Dehoux Laurène, Macher Marie-Alice, Niel Olivier, Kwon Thérésa, Deschênes Georges, Hogan Julien
Department of Paediatric Nephrology and Hemodialysis, Hôpital Robert Debré, APHP, 48 boulevard Sérurier 75019, 19, Paris Cedex, France.
BMC Nephrol. 2017 Dec 28;18(1):373. doi: 10.1186/s12882-017-0793-1.
Evaluation of patient's dry weight remains challenging in chronic hemodialysis (HD) especially in children. Inferior Vena Cava (IVC) measurement was reported useful to assess fluid overload both in adults and children.
We performed a monocentric prospective study to evaluate the relation between predialytic IVC diameter measurements and hydration status evaluated by physicians and bioimpedance spectroscopy (BIS) and between IVC measurements and persistent hypertension.
Forty-eight HD sessions in 16 patients were analyzed. According to physicians, patients were overhydrated in 84.5% of dialysis sessions, 20.8% according to BIS, and 0%, 4.1% and 20.8% according to IVC inspiratory, expiratory and collapsibility index reference curves respectively. There was no correlation between relative overhydration evaluated by BIS and IVC measurements z-scores (p = 0.20). Patients whose blood pressure normalized after HD had a more dilated maximal IVC diameter before dialysis session than patients with persistent hypertension (median - 0.07SD [-0.8; 0.88] versus -1.61SD [-2.18; -0.74] (p = 0.03)) with an optimal cut-off of -0.5 SD.
In our study, IVC measurement is not reliable to assess fluid overload in children on HD and was not correlated with extracellular fluid volume assessed by BIS measurements. However, IVC measurements might be of interest in differentiating volume-dependant hypertension from volume-independant hypertension.
在慢性血液透析（HD）中，评估患者的干体重仍然具有挑战性，尤其是在儿童患者中。据报道，下腔静脉（IVC）测量有助于评估成人和儿童的液体超负荷情况。
我们进行了一项单中心前瞻性研究，以评估透析前IVC直径测量值与医生评估的水化状态以及生物电阻抗光谱法（BIS）之间的关系，以及IVC测量值与持续性高血压之间的关系。
对16例患者的48次HD治疗进行了分析。根据医生的评估，在84.5%的透析治疗中患者存在水负荷过重；根据BIS评估，这一比例为20.8%；而根据IVC吸气、呼气和塌陷指数参考曲线评估，这一比例分别为0%、4.1%和20.8%。BIS评估的相对水负荷过重与IVC测量的z分数之间无相关性（p = 0.20）。HD后血压恢复正常的患者在透析前最大IVC直径比持续性高血压患者更扩张（中位数 -0.07标准差[-0.8; 0.88] 对 -1.61标准差[-2.18; -0.74]，p = 0.03），最佳截断值为-0.5标准差。
在我们的研究中，IVC测量在评估HD儿童的液体超负荷方面不可靠，且与BIS测量评估的细胞外液体积无关。然而，IVC测量在区分容量依赖性高血压和非容量依赖性高血压方面可能具有一定意义。
