Hou GuoCun, Gan Hua, Sun XiuLi, Li Jing
Chongqing Medical University, Chongqing 400016, China.
BaoTou Central Hospital Blood Purification Center, BaoTou 014040, China.
Biochem Biophys Rep. 2019 Jan 24;17:191-196. doi: 10.1016/j.bbrep.2019.01.005. eCollection 2019 Mar.
Fluid management using a body composition monitor (BCM) based on bioimpedance spectroscopy has been found to be beneficial for maintenance hemodialysis (MHD) patients. Our purpose was to provide a management procedure for the adjustment of post-dialysis overhydration (OH) and to evaluate whether this approach could improve blood pressure.
Post-dialysis fluid status was assessed weekly using the BCM. The reference value of OH and the flow procedure for post-dialysis target weight (PDTW) adjustment were established via measurements of OH in 60 normotensive MHD patients. In the interventional study, we adjusted the PDTW of hypertensive patients to the optimal OH range, with a 0.2-0.5 kg change in PDTW per week.
This observational study included 130 anuric MHD patients, of whom 60 were in the pre-dialysis systolic blood pressure (sBP) < 140 mmHg group. On multivariate logistic regression analysis, we found that only OH was significantly associated with sBP ≥ 140 mmHg (odds ratio = 2.293, = 0.000). Patients in the OH < -1.8 L group were mainly male and younger, and had higher post-dialysis diastolic blood pressure, ultrafiltration volume, levels of nutrition markers (serum albumin and creatinine), body mass index, and lean tissue index (LTI). On multiple stepwise regression analysis, only the change in LTI was found to be an independent predictor of OH [R 0.208, β = -0.196, 95% CI (-0.296, -0.095), < 0.001]. The reference value of OH was found to deviate by - 2.5-0.5 L from that of normotensive patients. At the end of the study, the systolic blood pressure of 38 patients was less than 140 mmHg after PDTW adjustment. The changes in OH from the initial to last adjustment were significant ( = 5.431, 0.001), with a substantial decrease in the sBP ( = 11.208, 0.001).
Assessment of OH and LTI using a BCM with a patient-specific optimal PDTW adjustment flow can lead to significantly better control of hypertension in anuric MHD patients.
已发现使用基于生物电阻抗光谱的人体成分监测仪（BCM）进行液体管理对维持性血液透析（MHD）患者有益。我们的目的是提供一种调整透析后水负荷过重（OH）的管理程序，并评估这种方法是否能改善血压。
每周使用BCM评估透析后的液体状态。通过测量60例血压正常的MHD患者的OH，确定OH的参考值和透析后目标体重（PDTW）调整的流程。在干预研究中，我们将高血压患者的PDTW调整到最佳OH范围，每周PDTW变化0.2 - 0.5 kg。
这项观察性研究包括130例无尿的MHD患者，其中60例处于透析前收缩压（sBP）< 140 mmHg组。在多因素逻辑回归分析中，我们发现只有OH与sBP≥140 mmHg显著相关（比值比 = 2.293， = 0.000）。OH < -1.8 L组的患者主要为男性且较年轻，透析后舒张压、超滤量、营养指标（血清白蛋白和肌酐）水平、体重指数和瘦组织指数（LTI）较高。在多元逐步回归分析中，仅发现LTI的变化是OH的独立预测因素[R 0.208，β = -0.196，95% CI（-0.296，-0.095）， < 0.001]。发现OH的参考值与血压正常患者的参考值相差 - 2.5 - 0.5 L。在研究结束时，38例患者在PDTW调整后收缩压低于140 mmHg。从初始调整到最后调整，OH的变化显著（ = 5.431， 0.001），sBP大幅下降（ = 11.208， 0.001）。
使用BCM评估OH和LTI，并采用针对患者的最佳PDTW调整流程，可显著更好地控制无尿MHD患者的高血压。
