低钠与常规钠透析液对家庭和自我护理卫星设施血液透析患者左心室质量的影响：一项随机临床试验。
Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial.
机构信息
Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
出版信息
J Am Soc Nephrol. 2020 May;31(5):1078-1091. doi: 10.1681/ASN.2019090877. Epub 2020 Mar 18.
BACKGROUND
Fluid overload in patients undergoing hemodialysis contributes to cardiovascular morbidity and mortality. There is a global trend to lower dialysate sodium with the goal of reducing fluid overload.
METHODS
To investigate whether lower dialysate sodium during hemodialysis reduces left ventricular mass, we conducted a randomized trial in which patients received either low-sodium dialysate (135 mM) or conventional dialysate (140 mM) for 12 months. We included participants who were aged >18 years old, had a predialysis serum sodium ≥135 mM, and were receiving hemodialysis at home or a self-care satellite facility. Exclusion criteria included hemodialysis frequency >3.5 times per week and use of sodium profiling or hemodiafiltration. The main outcome was left ventricular mass index by cardiac magnetic resonance imaging.
RESULTS
The 99 participants had a median age of 51 years old; 67 were men, 31 had diabetes mellitus, and 59 had left ventricular hypertrophy. Over 12 months of follow-up, relative to control, a dialysate sodium concentration of 135 mmol/L did not change the left ventricular mass index, despite significant reductions at 6 and 12 months in interdialytic weight gain, in extracellular fluid volume, and in plasma B-type natriuretic peptide concentration (ratio of intervention to control). The intervention increased intradialytic hypotension (odds ratio [OR], 7.5; 95% confidence interval [95% CI], 1.1 to 49.8 at 6 months and OR, 3.6; 95% CI, 0.5 to 28.8 at 12 months). Five participants in the intervention arm could not complete the trial because of hypotension. We found no effect on health-related quality of life measures, perceived thirst or xerostomia, or dietary sodium intake.
CONCLUSIONS
Dialysate sodium of 135 mmol/L did not reduce left ventricular mass relative to control, despite improving fluid status.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER
The Australian New Zealand Clinical Trials Registry, ACTRN12611000975998.
背景
接受血液透析的患者出现液体超负荷会导致心血管发病率和死亡率升高。全球范围内存在降低透析液钠浓度以减少液体超负荷的趋势。
方法
为了研究血液透析时使用较低浓度的透析液钠是否可以降低左心室质量，我们进行了一项随机试验，将接受血液透析的患者分为低钠透析液组（135mmol/L）或常规透析液组（140mmol/L），疗程为 12 个月。纳入标准为年龄＞18 岁、透析前血清钠≥135mmol/L、在家中或自我护理卫星设施中接受血液透析。排除标准包括每周透析频率＞3.5 次和使用钠谱或血液透析滤过。主要结局为心脏磁共振成像检测的左心室质量指数。
结果
99 例参与者的中位年龄为 51 岁；67 例男性，31 例患有糖尿病，59 例存在左心室肥厚。与对照组相比，在 12 个月的随访期间，尽管在 6 个月和 12 个月时，透析间体重增加、细胞外液体积和血浆 B 型利钠肽浓度比值均显著降低，但透析液钠浓度为 135mmol/L 并未改变左心室质量指数。该干预措施增加了透析中低血压（6 个月时比值比[OR]为 7.5；95%置信区间[95%CI]为 1.1 至 49.8，12 个月时 OR 为 3.6；95%CI 为 0.5 至 28.8）。干预组有 5 例患者因低血压无法完成试验。我们没有发现该干预措施对健康相关生活质量、口渴或口干、或膳食钠摄入量有影响。
结论
尽管液体状态得到改善，但与对照组相比，透析液钠浓度为 135mmol/L 并未降低左心室质量。
临床试验注册号
澳大利亚新西兰临床试验注册中心，ACTRN12611000975998。
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