Department of Medicine, Division of Nephrology, University of California San Diego, San Diego, CA, USA.
Altman Clinical and Translational Research Institute, UC San Diego, La Jolla, CA, USA.
Crit Care. 2021 Jan 6;25(1):18. doi: 10.1186/s13054-020-03441-0.
Intradialytic hypotension (IDH) is a frequent complication of intermittent hemodialysis (IHD), occurring from 15 to 50% of ambulatory sessions, and is more frequent among hospitalized patients with hypoalbuminemia. IDH limits adequate fluid removal and increases the risk for vascular access thrombosis, early hemodialysis (HD) termination, and mortality. Albumin infusion before and during therapy has been used for treating IDH with the varying results. We evaluated the efficacy of albumin infusion in preventing IDH during IHD in hypoalbuminemic inpatients.
A randomized, crossover trial was performed in 65 AKI or ESKD patients with hypoalbuminemia (albumin < 3 g/dl) who required HD during hospitalization. Patients were randomized to receive 100 ml of either 0.9%sodium chloride or 25% albumin intravenously at the initiation of each dialysis. These two solutions were alternated for up to six sessions. Patients' vital signs and ultrafiltration removal rate were recorded every 15 to 30 min during dialysis. IDH was assessed by different definitions reported in the literature. All symptoms associated with a noted hypotensive event as well as interventions during the dialysis were recorded.
Sixty-five patients were submitted to 249 sessions; the mean age was 58 ([Formula: see text] 12), and 46 (70%) were male with a mean weight of 76 ([Formula: see text] 18) kg. The presence of IDH was lower during albumin sessions based on all definitions. The hypotension risk was significantly decreased based on the Kidney Disease Outcomes Quality Initiative definition; (15% with NS vs. 7% with albumin, p = 0.002). The lowest intradialytic SBP was significantly worse in patients who received 0.9% sodium chloride than albumin (NS 83 vs. albumin 90 mmHg, p = 0.035). Overall ultrafiltration rate was significantly higher in the albumin therapies [NS - 8.25 ml/kg/h (- 11.18 5.80) vs. 8.27 ml/kg/h (- 12.22 to 5.53) with albumin, p = 0.011].
In hypoalbuminemic patients who need HD, albumin administration before the dialysis results in fewer episodes of hypotension and improves fluid removal. Albumin infusion may be of benefit to improve the safety of HD and achievement of fluid balance in these high-risk patients. ClinicalTrials.gov Identifier: NCT04522635.
透析中低血压（IDH）是间歇性血液透析（IHD）的常见并发症，在 15%至 50%的门诊治疗中发生，在低白蛋白血症的住院患者中更为常见。IDH 限制了充分的液体清除，并增加了血管通路血栓形成、早期血液透析（HD）终止和死亡的风险。在治疗前和治疗期间输注白蛋白已被用于治疗 IDH，但结果各不相同。我们评估了在低白蛋白血症住院患者的 IHD 中输注白蛋白预防 IDH 的疗效。
对 65 名 AKI 或 ESKD 合并低白蛋白血症（白蛋白<3g/dl）且需要住院期间进行 HD 的患者进行了一项随机、交叉试验。患者在每次透析开始时随机接受 100ml 0.9%氯化钠或 25%白蛋白静脉输注。这两种溶液最多交替使用六次。在透析过程中，每 15-30 分钟记录一次患者的生命体征和超滤去除率。IDH 通过文献报道的不同定义进行评估。记录所有与低血压事件相关的症状以及透析过程中的干预措施。
65 名患者接受了 249 次治疗；平均年龄为 58[公式：见正文]12 岁，46 名（70%）为男性，平均体重为 76[公式：见正文]18 公斤。根据所有定义，白蛋白治疗期间 IDH 的发生率较低。根据肾脏病预后质量倡议（Kidney Disease Outcomes Quality Initiative，KDOQI）的定义，低血压风险显著降低；（NS 组为 15%，白蛋白组为 7%，p=0.002）。接受 0.9%氯化钠治疗的患者透析期间的最低收缩压明显更差（NS 组 83mmHg，白蛋白组 90mmHg，p=0.035）。白蛋白治疗的总体超滤率明显更高[NS 组-8.25ml/kg/h（-11.18 5.80）vs. 白蛋白组 8.27ml/kg/h（-12.22 至 5.53），p=0.011]。
在需要 HD 的低白蛋白血症患者中，透析前给予白蛋白可减少低血压发作次数，并改善液体清除。在这些高危患者中，输注白蛋白可能有助于提高 HD 的安全性并实现液体平衡。临床试验注册号：NCT04522635。
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