Patel H V, Annigeri R A, Kowdle P C, Rao B S, Seshadri R, Balasubramanian S, Vadamalai V
Department of Nephrology, Apollo Hospitals, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2019 Jan-Feb;29(1):1-7. doi: 10.4103/ijn.IJN_150_18.
Chronic fluid overload as well as excessive fluid removal are associated with increased morbidity and mortality in hemodialysis (HD) patients. The clinical method to probe the dry weight is often inaccurate and the bioimpedance spectroscopy (BIS) is shown to improve the accuracy. We compared the impact of BIS and clinical methods to guide ultrafiltration (UF) in a randomized controlled study on the intradialytic complications and blood pressure control in prevalent HD patients. Fifty patients on maintenance HD were randomized to BIS method (BIS-group) and clinical method (CL-group) to guide UF. The body composition monitor (BCM) was done post-HD in all patients at baseline and 2-weeks interval during the study period of 6 months to determine the hydration status, but the result was revealed only to the nephrologist managing the patients in BIS-group to probe the dry weight. The endpoints of the study were blood pressure control, intradialytic complications and anti-hypertensive drug burden. The mean age was 56.0 ± 12.0 years and 70% were male. There was significant increase in patients with normal hydration in BIS-group (20% vs. 88%, = 0.0001), but remained similar to baseline in CL-group (40% vs. 48%, = 0.3) at 6 months. The incidence of intradialytic hypotension was significantly reduced in BIS-group (4.84 ± 3.0 vs. 2.8 ± 3.13 events/patient/6 months, = 0.003). There was 35% reduction in hypertensive pill burden in BIS-group with similar blood pressure, compared to CL-group. Post-dialysis underhydration was more common than over or normal hydration at baseline in our population, indicating that clinical method to probe dry weight often resulted in hypovolemia. BIS method to determine dry weight resulted in normalization in volume status and consequently resulted in significant reduction in intradialytic hypotension and anti-hypertensive pill burden over 6-month period.
慢性液体超负荷以及过度的液体清除与血液透析（HD）患者发病率和死亡率的增加相关。探寻干体重的临床方法往往不准确，而生物电阻抗光谱法（BIS）已被证明能提高准确性。在一项关于维持性HD患者透析期间并发症和血压控制的随机对照研究中，我们比较了BIS和临床方法对指导超滤（UF）的影响。50例维持性HD患者被随机分为BIS组和临床方法组（CL组）以指导UF。在为期6个月的研究期间，所有患者在基线时以及每2周进行一次HD后进行人体成分监测（BCM），以确定水合状态，但结果仅向BIS组中管理患者的肾病专家透露以探寻干体重。研究的终点是血压控制、透析期间并发症和抗高血压药物负担。平均年龄为56.0±12.0岁，70%为男性。6个月时，BIS组中水合正常的患者显著增加（20%对88%，P = 0.0001），而CL组与基线相似（4%对48%，P = = 0.3）。BIS组透析期间低血压的发生率显著降低（4.84±3.0对2.8±3.13次事件/患者/6个月，P = 0.003）。与CL组相比，BIS组在血压相似的情况下，抗高血压药物负担降低了35%。在我们的研究人群中，透析后脱水在基线时比水合过多或正常更为常见，这表明探寻干体重的临床方法常常导致血容量不足。BIS方法确定干体重可使容量状态正常化，因此在6个月期间显著降低了透析期间低血压和抗高血压药物负担。
