Department of Nephrology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
Universidad de Alcalá, Madrid, Spain.
Hemodial Int. 2022 Jan;26(1):30-37. doi: 10.1111/hdi.12957. Epub 2021 Jun 28.
Although relationship between dialysate sodium concentration and hemodynamic stability has been well studied over the years, outcomes of absolute blood volume (ABV) maintenance and vascular refilling volume (V ) modifications were not included, as its analysis has not been easily accessible to direct investigation. However, recent studies report a simple and feasible methodology to assess ABV and V during hemodialysis (HD) treatments. It is the aim of this study to analyze whether sodium concentration in dialysate modifies ABV drop and V .
The study was performed in 19 patients under HD. During three different sessions, sodium concentration in dialysate was randomized to three different profiles: low sodium concentration (LNa, 138 mEq/L), neutral sodium concentration (NNa, 140 mEq/L), and high sodium concentration (HNa, 143 mEq/L). ABV and V were calculated using Kron et al methodology.
Predialysis values of the measured parameters showed similar results for the three profiles. Sodium concentration showed an effect on ABV drop, V and vascular refilling fraction (F ). Pair-wise comparison revealed mean ABV decreased 0.21 L less when using HNa profile versus LNa profile (p = 0.027), a mean V increase of 0.39 L (p = 0.038), and a mean F increase of 9.94% (p = 0.048).
This study shows that the use of HNa profiles increases V and F and reduces ABV drop during dialysis treatments when compared to LNa profiles.
尽管多年来人们已经很好地研究了透析液钠浓度与血液动力学稳定性之间的关系，但并未包括绝对血容量（ABV）维持和血管再充盈量（V）的改变，因为其分析不易直接进行调查。然而，最近的研究报告了一种简单可行的方法来评估血液透析（HD）治疗期间的 ABV 和 V。本研究旨在分析透析液中的钠浓度是否会改变 ABV 下降和 V。
该研究在 19 名接受 HD 的患者中进行。在三个不同的治疗过程中，透析液中的钠浓度随机分为三个不同的浓度：低钠浓度（LNa，138mEq/L）、中性钠浓度（NNa，140mEq/L）和高钠浓度（HNa，143mEq/L）。使用 Kron 等人的方法计算 ABV 和 V。
三种方案的预透析测量参数值显示出相似的结果。钠浓度对 ABV 下降、V 和血管再充盈分数（F）有影响。两两比较显示，与 LNa 方案相比，使用 HNa 方案时 ABV 下降减少了 0.21L（p=0.027），V 增加了 0.39L（p=0.038），F 增加了 9.94%（p=0.048）。
与 LNa 方案相比，本研究表明在透析治疗中使用 HNa 方案可增加 V 和 F，并减少 ABV 下降。
