血液透析期间血浆钠浓度对血压调节因子的影响：一项随机交叉研究。
Effect of plasma sodium concentration on blood pressure regulators during hemodialysis: a randomized crossover study.
作者信息
Ettema Esmée M, Kuipers Johanna, van Faassen Martijn, Groen Henk, van Roon Arie M, Lefrandt Joop D, Westerhuis Ralf, Kema Ido P, van Goor Harry, Gansevoort Ron T, Gaillard Carlo A J M, Franssen Casper F M
机构信息
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, PO box 30, 001 9700, RB, Groningen, The Netherlands.
Dialysis Center Groningen, Groningen, The Netherlands.
出版信息
BMC Nephrol. 2018 Aug 22;19(1):214. doi: 10.1186/s12882-018-0997-z.
BACKGROUND
Intradialytic hypotension is a common complication of hemodialysis. The Hemocontrol biofeedback system, improving intradialytic hemodynamic stability, is associated with an initial transient increase in plasma sodium levels. Increases in sodium could affect blood pressure regulators.
METHODS
We investigated whether Hemocontrol dialysis affects vasopressin and copeptin levels, endothelial function, and sympathetic activity in twenty-nine chronic hemodialysis patients. Each patient underwent one standard hemodialysis and one Hemocontrol hemodialysis. Plasma sodium, osmolality, nitrite and nitrate (NOx), endothelin-1, angiopoietins-1 and 2, and methemoglobin as measures of endothelial function, plasma catecholamines as indices of sympathetic activity and plasma vasopressin and copeptin levels were measured six times during each modality. Blood pressure, heart rate, blood volume, and heart rate variability were repeatedly monitored. Generalized Estimating Equations was used to compare the course of the parameters during the two treatment modalities.
RESULTS
Plasma sodium and osmolality were significantly higher during the first two hours of Hemocontrol hemodialysis. Overall, mean arterial pressure (MAP) was higher during Hemocontrol dialysis. Neither the measures of endothelial function and sympathetic activity nor copeptin levels differed between the two dialysis modalities. In contrast, plasma vasopressin levels were significantly higher during the first half of Hemocontrol dialysis. The intradialytic course of vasopressin was associated with the course of MAP.
CONCLUSIONS
A transient intradialytic increase in plasma sodium did not affect indices of endothelial function or sympathetic activity compared with standard hemodialysis, but coincided with higher plasma vasopressin levels. The beneficial effect of higher intradialytic sodium levels on hemodynamic stability might be mediated by vasopressin.
TRIAL REGISTRATION
ClinicalTrials.gov. Identifier: NCT03578510 . Date of registration: July 5th, 2018. Retrospectively registered.
背景
透析中低血压是血液透析的常见并发症。Hemocontrol生物反馈系统可改善透析中的血流动力学稳定性，与血浆钠水平最初的短暂升高有关。钠的增加可能会影响血压调节因子。
方法
我们调查了Hemocontrol透析是否会影响29例慢性血液透析患者的血管加压素和 copeptin水平、内皮功能及交感神经活动。每位患者分别接受一次标准血液透析和一次Hemocontrol血液透析。在每种透析方式期间，六次测量血浆钠、渗透压、亚硝酸盐和硝酸盐（NOx）、内皮素-1、血管生成素-1和2以及高铁血红蛋白作为内皮功能指标，测量血浆儿茶酚胺作为交感神经活动指标，测量血浆血管加压素和copeptin水平。反复监测血压、心率、血容量和心率变异性。使用广义估计方程比较两种治疗方式期间参数的变化过程。
结果
在Hemocontrol血液透析的前两小时，血浆钠和渗透压显著更高。总体而言，Hemocontrol透析期间平均动脉压（MAP）更高。两种透析方式之间，内皮功能和交感神经活动指标以及copeptin水平均无差异。相比之下，在Hemocontrol透析的前半段，血浆血管加压素水平显著更高。血管加压素的透析内变化过程与MAP的变化过程相关。
结论
与标准血液透析相比，透析期间血浆钠的短暂升高并未影响内皮功能或交感神经活动指标，但与更高的血浆血管加压素水平同时出现。透析期间较高的钠水平对血流动力学稳定性的有益作用可能由血管加压素介导。
试验注册
ClinicalTrials.gov。标识符：NCT03578510。注册日期：2018年7月5日。回顾性注册。
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