Department of Neurology, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Biostatistics, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA.
Perit Dial Int. 2021 Jul;41(4):417-422. doi: 10.1177/0896860820953712. Epub 2020 Sep 10.
This study evaluated intradialytic cerebral hemodynamics measured by transcranial Doppler (TCD) in intermittent hemodialysis (iHD) versus nightly peritoneal dialysis (NIPD). Intradialytic TCD was serially performed in chronic dialysis patients receiving iHD ( = 10) and NIPD ( = 10). A linear mixed model was used to model mean flow velocity (MFV), pulsatility index (PI), and mean arterial pressure (MAP) as functions of time and treatment group. Intradialytic cerebral volatility (IDCV) was calculated using the coefficient of variation (CV) and mean absolute value of change (AVC) of each patient's MFV, PI, and MAP values over time. Mixed model analyses found no significant difference between MFV, PI, and MAP treatment groups in change over time, though volatility differed significantly. Mean CV values for MFV, PI, and MAP were higher in iHD than NIPD (MFV 0.22 vs. 0.10, = 0.005; PI 0.14 vs. 0.08, = 0.003; MAP 0.057 vs. 0.032, = 0.009). AVC values were similarly higher in iHD compared to NIPD (MFV 8.26 vs. 4.43, = 0.04; PI 0.17 vs. 0.084, < 0.001; MAP 6.05 vs. 2.9, = 0.003). PI, MFV, and MAP were more stable in NIPD than iHD, as measured by intradialytic TCD monitoring. This study identifies IDCV as a unique TCD metric for intradialytic cerebral hemodynamics.
这项研究评估了通过经颅多普勒（TCD）测量的间歇性血液透析（iHD）与夜间腹膜透析（NIPD）的透析内大脑血液动力学。对接受 iHD（n=10）和 NIPD（n=10）的慢性透析患者进行了连续透析内 TCD。使用线性混合模型将平均血流速度（MFV）、搏动指数（PI）和平均动脉压（MAP）作为时间和治疗组的函数进行建模。使用每个患者的 MFV、PI 和 MAP 值的变异系数（CV）和绝对值变化（AVC）计算透析内大脑波动率（IDCV）。混合模型分析发现，MFV、PI 和 MAP 治疗组之间的时间变化没有显著差异，但波动率差异显著。iHD 的 MFV、PI 和 MAP 的平均 CV 值高于 NIPD（MFV 0.22 与 0.10， = 0.005；PI 0.14 与 0.08， = 0.003；MAP 0.057 与 0.032， = 0.009）。与 NIPD 相比，iHD 的 AVC 值也明显更高（MFV 8.26 与 4.43， = 0.04；PI 0.17 与 0.084， < 0.001；MAP 6.05 与 2.9， = 0.003）。通过透析内 TCD 监测，PI、MFV 和 MAP 在 NIPD 中比 iHD 更稳定。这项研究确定 IDCV 是透析内大脑血液动力学的独特 TCD 指标。
