在间歇性输液血液透析滤过中，推注式透析液输注剂量与血压之间的关系。

Relationship between Dose of Bolus Dialysate Infusion and Blood Pressure in Intermittent Infusion Hemodiafiltration.

机构信息

Department of Blood Purification, Tohto Sangenjaya Clinic, Tokyo, Japan,

Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan,

出版信息

Blood Purif. 2019;48 Suppl 1:27-32. doi: 10.1159/000503892. Epub 2019 Nov 21.

DOI:10.1159/000503892

PMID:31752008

Abstract

BACKGROUND

Intermittent infusion hemodiaﬁltration is a recently developed convective method of renal replacement therapy using cyclic back-ﬁltration infusion. Quick and regular infusion prevents intradialytic hypotension. However, the optimal dose of bolus dialysate infusion required to stabilize blood pressure has not been reported. Here, we investigated the relationship between the dose of bolus dialysate infusion and blood pressure.

SUMMARY

A total of 77 patients on maintenance hemodialysis were enrolled in this study. Dialysate was infused rapidly by backward ﬁltration at a rate of 150 mL/min at 30-min intervals using an automated dialysis machine. The effects with two bolus infusion volumes (100 and 200 mL) were compared, each for an observation period of 2 weeks. Systolic blood pressure (SBP) was measured at the start and at the end of each dialysis session, and the highest SBP and lowest SBP measurements were also recorded. Patients were divided according to dry weight into a <52 kg group and a ≥52 kg group, and various parameters were compared between the 100 and 200 mL bolus infusion volumes in each group. Among patients in the <52 kg group, SBP did not vary at any of the time points. However, for patients in the ≥52 kg group, SBP at the end of treatment was significantly lower in the 100-mL group than in the 200-mL group (141 ± 20 vs. 144 ± 21 mm Hg, p = 0.041), and the minimum SBP was also lower in the 100-mL group than in the 200-mL group (127 ± 17 vs. 131 ± 18 mm Hg, p = 0.010). Key Messages: Among patients with a dry weight of ≥52 kg, blood pressure was more stable when a bolus fluid volume of 200 mL was used, compared with a volume of 100 mL. However, for patients with a dry weight of <52 kg, the significance of the difference in bolus fluid volumes disappeared. Thus, the replacement fluid volume might be better determined based on the patient's dry weight.

TRIAL REGISTRATION

UMIN 000028145, Registered July 10, 2017.

摘要

背景

间歇性输注血液透析滤过是一种最近开发的使用循环后向输注的对流性肾脏替代治疗方法。快速而规律的输注可防止透析中低血压。然而，尚未报道稳定血压所需的推注透析液剂量。在这里，我们研究了推注透析液剂量与血压之间的关系。

总结

本研究共纳入 77 例维持性血液透析患者。使用自动透析机以 150mL/min 的速度在 30 分钟间隔内通过后向过滤快速输注透析液。比较了两种推注体积（100 和 200mL）的效果，每种体积各观察 2 周。在每次透析开始和结束时测量收缩压（SBP），并记录最高 SBP 和最低 SBP 测量值。根据干体重将患者分为<52kg 组和≥52kg 组，并在每组中比较了 100 和 200mL 推注体积的各种参数。在<52kg 组中，任何时间点的 SBP 均无变化。然而，对于≥52kg 组的患者，治疗结束时 100mL 组的 SBP 明显低于 200mL 组（141±20 与 144±21mmHg，p=0.041），且最低 SBP 也低于 200mL 组（127±17 与 131±18mmHg，p=0.010）。