Ficheux Alain, Gayrard Nathalie, Szwarc Ilan, Duranton Flore, Vetromile Fernando, Brunet Philippe, Servel Marie-Françoise, Jankowski Joachim, Argilés Àngel
RD - Néphrologie, Montpellier, France.
BC2M, Univ Montpellier, Montpellier, France.
Clin Kidney J. 2019 Apr 19;13(4):580-586. doi: 10.1093/ckj/sfz033. eCollection 2020 Aug.
Post-dilutional haemodiafiltration (HDF) with high convection volumes (HCVs) could improve survival. HCV-HDF requires a significant pressure to be applied to the dialyser membrane. The aim of this study was to assess the pressure applied to the dialysers in HCV-HDF, evaluate the influence of transmembrane pressure (TMP) calculation methods on TMP values and check how they relate to the safety limits proposed by guidelines.
Nine stable dialysis patients were treated with post-dilutional HCV-HDF with three different convection volumes [including haemodialysis (HD)]. The pressures at blood inlet (B), blood outlet (B) and dialysate outlet (D) were continuously recorded. TMP was calculated using two pressures (TMP2: B, D) or three pressures (TMP3: B, D, B). Dialysis parameters were analysed at the start of the session and at the end of treatment or at the first occurrence of a manual intervention to decrease convection due to TMP alarms.
During HD sessions, TMP2 and TMP3 remained stable. During HCV-HDF, TMP2 remained stable while TMP3 clearly increased. For the same condition, TMP3 could be 3-fold greater than TMP2. This shows that the TMP limit of 300 mmHg as recommended by guidelines could have different effects according to the TMP calculation method. In HCV-HDF, the pressure at the B increased over time and exceeded the safety limits of 600 mmHg provided by the manufacturer, even when respecting TMP safety limits.
This study draws our attention to the dangers of using a two-pressure points TMP calculation, particularly when performing HCV-HDF.
采用高对流容积（HCV）的后置稀释血液透析滤过（HDF）可提高生存率。HCV-HDF需要对透析器膜施加较大压力。本研究的目的是评估HCV-HDF中施加于透析器的压力，评估跨膜压（TMP）计算方法对TMP值的影响，并检查它们与指南提出的安全限值的关系。
9例稳定的透析患者接受了三种不同对流容积的后置稀释HCV-HDF治疗[包括血液透析（HD）]。连续记录血液入口（B）、血液出口（B）和透析液出口（D）处的压力。使用两个压力（TMP2：B、D）或三个压力（TMP3：B、D、B）计算TMP。在治疗开始时、治疗结束时或因TMP警报首次进行手动干预以降低对流时分析透析参数。
在HD治疗期间，TMP2和TMP3保持稳定。在HCV-HDF期间，TMP2保持稳定而TMP3明显升高。在相同条件下，TMP3可能比TMP2大3倍。这表明，指南推荐的300 mmHg的TMP限值根据TMP计算方法可能有不同影响。在HCV-HDF中，B处的压力随时间增加，即使遵守TMP安全限值，也超过了制造商规定的600 mmHg的安全限值。
本研究使我们注意到使用两点压力TMP计算的危险性，特别是在进行HCV-HDF时。
