NephroCare France, Nephrology & Dialysis, Fresnes, Île-de-France, France.
F-CRIN Investigation Network Initiative and Renal Clinical Network Trialist, Nancy, France.
Nephrol Dial Transplant. 2019 Dec 1;34(12):2089-2095. doi: 10.1093/ndt/gfz141.
Fluid overload is frequent among hemodialysis (HD) patients. Dialysis therapy itself may favor sodium imbalance from sodium dialysate prescription. As on-line hemodiafiltration (OL-HDF) requires large amounts of dialysate infusion, this technique can expose to fluid accumulation in case of a positive sodium gradient between dialysate and plasma. To evaluate this risk, we have analyzed and compared the fluid status of patients treated with HD or OL-HDF in French NephroCare centers.
This is a cross-sectional and retrospective analysis of prevalent dialysis patients. Data were extracted from the EUCLID5 data base. Patients were split in 2 groups (HD and OL-HDF) and compared as whole group or matched patients for fluid status criteria including predialysis relative fluid overload (RelFO%) status from the BCM®.
2242 patients (age 71 years; female: 39%; vintage: 38 months; Charlson index: 6) were studied. 58% of the cohort were prescribed post-dilution OL-HDF. Comparing the HD and OL-HDF groups, there was no difference between HD and OL-HDF patients regarding the predialysis systolic BP, the interdialytic weight gain, the dialysate-plasma sodium gradient, and the predialysis RelFO%. The stepwise logistic regression did not find dialysis modality (HD or OL-HDF) associated with fluid overload or high predialysis systolic blood pressure. In OL-HDF patients, monthly average convective or weekly infusion volumes per session were not related with the presence of fluid overload.
In this cross-sectional study we did not find association between the use of post-dilution OL-HDF and markers of fluid volume excess. Aligned dialysis fluid sodium concentrations to patient predialysis plasma sodium and regular monitoring of fluid volume status by bioimpedance spectroscopy may have been helpful to manage adequately the fluid status in both OL-HDF and HD patients.
血液透析（HD）患者经常出现液体超负荷。透析治疗本身可能会导致透析液处方中的钠不平衡。由于在线血液透析滤过（OL-HDF）需要大量透析液输注，如果透析液和血浆之间存在正钠梯度，这种技术可能会导致液体蓄积。为了评估这种风险，我们分析并比较了法国 NephroCare 中心接受 HD 或 OL-HDF 治疗的患者的液体状态。
这是一项对现有透析患者的横断面和回顾性分析。数据从 EUCLID5 数据库中提取。患者分为 2 组（HD 和 OL-HDF），并根据液体状态标准（包括 BCM®的预透析相对液体超负荷（RelFO%）状态）对整个组或匹配患者进行比较。
共纳入 2242 例患者（年龄 71 岁；女性：39%；使用时间：38 个月；Charlson 指数：6）。58%的患者接受了后稀释 OL-HDF 治疗。与 HD 组相比，OL-HDF 组患者的预透析收缩压、透析间期体重增加、透析液-血浆钠梯度和预透析 RelFO%无差异。逐步逻辑回归未发现透析方式（HD 或 OL-HDF）与液体超负荷或高预透析收缩压相关。在 OL-HDF 患者中，每月平均对流或每周输注量与液体超负荷无关。
在这项横断面研究中，我们未发现后稀释 OL-HDF 的使用与液体容量过多的标志物之间存在关联。将透析液钠浓度与患者预透析血浆钠浓度保持一致，并通过生物阻抗谱法定期监测液体容量状态，可能有助于对 OL-HDF 和 HD 患者的液体状态进行适当管理。
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