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用于水化评估的多方法综合方法未检测到血液透析与腹膜透析患者之间的水化差异。

Multi-Method Complex Approach for Hydration Assessment Does Not Detect a Hydration Difference in Hemodialysis versus Peritoneal Dialysis Patient.

作者信息

Adamska-Wełnicka Anna, Wełnicki Marcin, Krzesiński Paweł, Niemczyk Stanisław, Lubas Arkadiusz

机构信息

Clinic of Nephrology and Internal Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland.

3rd Clinic of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland.

出版信息

Diagnostics (Basel). 2020 Sep 29;10(10):767. doi: 10.3390/diagnostics10100767.

Abstract

Assessment of hydration status is essential in monitoring the effectiveness of renal replacement therapy and is usually based on physical examination. However, comparisons of hydration status achieved with different dialysis methods are not conclusive. We compared the hydration status of patients on chronic hemodialysis (HD, = 60) and peritoneal dialysis (PD, = 20) in a comprehensive assessment including physical examination and additional methods. The mean age of the 80 chronically dialyzed patients (53 males, 27 females) was 58.1 ± 13.9 years. The clinical evaluation took into account the presence of peripheral edema, dyspnea, and crackling over the lung fields. Additional tests included lung ultrasound, electrical bioimpedance (performed in 79 patients), impedance cardiography, ultrasound assessment of large abdominal vessels (performed in 79 patients), select echocardiographic parameters (obtained in 78 patients), and serum NT-proBNP concentration. Residual diuresis volume was significantly higher in the PD group. We found no significant differences between the two groups in any other baseline characteristics or in the results of the clinical examination or additional tests. The use of different methods for assessing hydration does not allow differentiation of patients treated with dialysis in terms of the dialysis technique used. Therefore, it seems reasonable to use common algorithms to objectify the hydration status of these patients.

摘要

评估水合状态对于监测肾脏替代治疗的效果至关重要,通常基于体格检查。然而,不同透析方法所达到的水合状态的比较尚无定论。我们在包括体格检查和其他方法的综合评估中,比较了接受慢性血液透析(HD,n = 60)和腹膜透析(PD,n = 20)患者的水合状态。80例长期透析患者(53例男性,27例女性)的平均年龄为58.1±13.9岁。临床评估考虑了外周水肿、呼吸困难和肺野啰音的存在。其他检查包括肺部超声、生物电阻抗(79例患者进行此项检查)、阻抗心动图、腹部大血管超声评估(79例患者进行此项检查)、部分超声心动图参数(78例患者获得此项参数)以及血清N末端脑钠肽前体(NT-proBNP)浓度。腹膜透析组的残余尿量显著更高。我们发现两组在任何其他基线特征、临床检查结果或其他检查方面均无显著差异。使用不同方法评估水合状态并不能根据所采用的透析技术区分接受透析治疗的患者。因此,使用通用算法来客观评估这些患者的水合状态似乎是合理的。

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本文引用的文献

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Overhydration, Cardiac Function and Survival in Hemodialysis Patients.血液透析患者的水钠潴留、心脏功能与生存情况
PLoS One. 2015 Aug 14;10(8):e0135691. doi: 10.1371/journal.pone.0135691. eCollection 2015.

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