Ismail Abdul Hamid, Gross Theresa, Schlieper Georg, Walter Marian, Eitner Frank, Floege Jürgen, Leonhardt Steffen
Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
Department of Nephrology (Medical Clinic II), RWTH Aachen University Hospital, Aachen, Germany.
Clin Kidney J. 2019 Sep 17;14(1):149-155. doi: 10.1093/ckj/sfz123. eCollection 2021 Jan.
Transcellular fluid shifts during dialysis treatment could be related to the frequency and severity of intradialytic hypotension (IDH). We investigated that (i) in addition to ultrafiltration, extracellular fluid (ECF) is further depleted by transcellular fluid shifts and (ii) changes in intracellular fluid (ICF), which have been overlooked so far, or if they were considered, are not understood, might be due to these fluid shifts.
Thirty-six patients were categorized as haemodynamically stable, asymptomatic IDH or unstable (symptomatic IDH) according to their changes in systolic blood pressure and associated clinical symptoms. Their intradialytic changes in body fluids were studied using bioimpedance spectroscopy measurements and compared among groups.
For IDH-prone patients, data showed a rapid drop in ECF that was more than expected from the ultrafiltration rate (UFR) profile and was associated with a significant increase in ICF (P = 0.001). Study of accumulative loss profiles of ECF revealed a loss in ECF up to 300 ml, more than that predicted from UFR for unstable patients.
The considerable discrepancy between the expected and measured loss in ECF might provide evidence of transcellular fluid shifts possibly induced by changes in plasma osmolarity due to haemodialysis. Moreover, the results suggest a pattern of fluid removal in IDH-prone patients that significantly differs from that in haemodynamically stable patients.
透析治疗期间的跨细胞液转移可能与透析中低血压（IDH）的发生频率和严重程度有关。我们研究了：（i）除超滤外，跨细胞液转移会使细胞外液（ECF）进一步减少；（ii）细胞内液（ICF）的变化可能是由于这些液体转移所致，而这一点在以往一直被忽视，或者即便被考虑到，也未被理解。
根据收缩压变化及相关临床症状，将36例患者分为血流动力学稳定、无症状IDH或不稳定（有症状IDH）三组。采用生物电阻抗光谱测量法研究他们透析期间的体液变化，并在组间进行比较。
对于易发生IDH的患者，数据显示ECF迅速下降，下降幅度超过超滤率（UFR）预期，且与ICF显著增加相关（P = 0.001）。对ECF累积丢失情况的研究发现，不稳定患者的ECF丢失量高达300 ml，超过UFR预测值。
ECF预期丢失量与实测丢失量之间的显著差异可能为血液透析导致血浆渗透压变化引起的跨细胞液转移提供证据。此外，结果表明易发生IDH的患者的液体清除模式与血流动力学稳定的患者有显著差异。
