Puntoni Alessandro, Giannese Domenico, Varricchio Enrico, D'Alessandro Claudia, Egidi Maria Francesca, Cupisti Adamasco
Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa.
U.O. Nefrologia Trapianti e Dialisi, AOUP, Pisa.
G Ital Nefrol. 2020 Feb 12;37(1):2020-vol1.
Estimating the euvolemia and dry weight of hemodialysis patients still represents a challenge for the nephrologist, since both dehydration and hyperhydration are associated with intradialytic events and cardiovascular complications in the short and long term. Despite the need for a precise and objective definition of the dry weight for the individual patient on dialysis, this is usually determined on a clinical basis. To obtain greater sensitivity the dosage of natriuretic peptides, Bioelectrical Impedance Analysis (BIA) and, more recently, Lung Ultra-Sound (LUS) can all be used. The BIA allows to estimate the subject's body composition and, in particular, the distribution of body fluids. The presence of hyperhydration, as determined through the BIA, is predictive of an increased mortality in numerous observational studies. In recent years, pulmonary ultrasound has taken on an increasingly important role not only within the cardiology and intensive care units, but also in a nephrology setting, especially in dialysis. The purpose of this article is to analyze the advantages and limitations of the methods that can be used to assess the dry weight of patients undergoing hemodialysis treatment.
对肾病学家而言,估算血液透析患者的血容量正常状态和干体重仍是一项挑战,因为脱水和水合过多在短期和长期内均与透析期间的事件及心血管并发症相关。尽管需要为透析患者个体精确、客观地定义干体重,但这通常是基于临床来确定的。为了提高敏感性,可以使用利钠肽剂量测定、生物电阻抗分析(BIA),以及最近的肺部超声检查(LUS)。BIA能够估算受试者的身体组成,尤其是体液分布。通过BIA确定的水合过多状态在众多观察性研究中可预测死亡率增加。近年来,肺部超声不仅在心脏病学和重症监护病房中发挥着越来越重要的作用,而且在肾脏病领域,尤其是在透析方面也日益重要。本文旨在分析可用于评估接受血液透析治疗患者干体重的方法的优缺点。