Department of Nephrology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Universidad de Alcalá, Madrid, Spain.
Semin Dial. 2021 Jul;34(4):309-314. doi: 10.1111/sdi.12958. Epub 2021 Feb 13.
Vascular refilling occurs to preserve hemodynamic stability during hemodialysis (HD). Recent studies report a feasible and noninvasive method to determine absolute blood volume (ABV), and estimate vascular refilling during HD. The objective of this study is to analyze if lowering dialysate temperature modifies variations in ABV during HD.
The study was performed in 50 patients under HD. During two different sessions, relative blood volume was assessed using dialysate temperatures of 35.5°C (cool dialysate) and 36.5°C (neutral dialysate). ABV and vascular refilling were calculated using Kron et al methodology.
Thirty-nine intradialytic morbid events (IMEs) were observed in 30 patients, 14 under cool dialysate and 25 during neutral dialysate. We did not found statistically differences in ABV or in refilling volume between cool and neutral temperature. When analyzing apart only those patients who presented IME, we observed lower drop in ABV in the 35.5°C dialysate treatments (0.57 L) versus 36.5°C dialysate treatments (0.71 L). When cool dialysate was used, the vascular refilling fraction tended to be higher, but data did not turn statistically significant.
In selected groups of patients the use of cool dialysate induces lower ABV variations that could improve hemodynamic stability during HD treatments.
在血液透析（HD）过程中，血管再充盈可维持血液动力学稳定。最近的研究报告了一种可行且无创的方法来确定绝对血容量（ABV），并估计 HD 过程中的血管再充盈。本研究旨在分析降低透析液温度是否会改变 HD 过程中 ABV 的变化。
该研究在 50 名接受 HD 的患者中进行。在两个不同的疗程中，使用 35.5°C（冷却透析液）和 36.5°C（中性透析液）的透析液温度评估相对血容量。使用 Kron 等人的方法计算 ABV 和血管再充盈。
30 名患者中有 39 名发生了 39 次透析中并发症（IMEs），其中 14 名在冷却透析液下发生，25 名在中性透析液下发生。我们没有发现冷却和中性温度之间 ABV 或再充盈量的统计学差异。当单独分析那些出现 IME 的患者时，我们观察到在 35.5°C 透析液治疗中 ABV 的下降幅度较低（0.57 L），而在 36.5°C 透析液治疗中下降幅度较高（0.71 L）。当使用冷却透析液时，血管再充盈分数趋于较高，但数据无统计学意义。
在选定的患者群体中，使用冷却透析液可降低 ABV 的变化，从而改善 HD 治疗期间的血液动力学稳定性。
