Department of Internal Medicine, Division of Nephrology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.
Ren Fail. 2021 Dec;43(1):1446-1453. doi: 10.1080/0886022X.2021.1988639.
This study was designed to identify the fluid spaces that are most changed during ultrafiltration (UF) according to intradialytic blood pressure (BP) difference. BP data were collected five times (before hemodialysis [HD] and 1-4 h of HD). Intradialytic BP difference was calculated as the highest minus lowest of these BP measurements. Intradialytic systolic BP (SBP) difference over 20 mm Hg and diastolic BP (DBP) difference over 10 mm Hg were defined as wide intradialytic SBP difference (SYS-W) and DBP difference (DIA-W), respectively. We measured the various fluid spaces before HD and 1-4 h of HD, and 30 min after HD using a portable, whole-body bioimpedance spectroscopy (BIS). In this study, 85 prevalent patients aged over 18 years with a fixed dry weight (65.38 ± 12.45 years, 54.18% men, 52.50% patients with diabetes), undergoing HD had participated. 1) Mean relative reduction of extracellular water (ECW) was significantly higher in SYS-W than in narrow intradialytic SBP difference (SYS-N) patients from 1 h to 30 min after HD. 2) Mean relative reduction of intracellular water (ICW) was significantly lower in DIA-W than in narrow intradialytic DBP difference (DIA-N) patients from 1 h to 30 min after HD. 3) ECW of patients with SYS-W was significantly lower than that of patients with SYS-N. Patients with SYS-W have the characteristics of fluid shifts in which reduction of ECW was steeper than patients with SYS-N whereas fluid shifts of ICW were lower in patients with DIA-W than patients with DIA-N.
这项研究旨在根据透析中血压（BP）差异确定超滤（UF）过程中变化最大的液体空间。BP 数据采集了五次（在血液透析前和血液透析 1-4 小时）。透析中 BP 差异是通过这些 BP 测量的最高值减去最低值计算得出的。透析中收缩压（SBP）差异超过 20mmHg 和舒张压（DBP）差异超过 10mmHg 分别定义为宽透析 SBP 差异（SYS-W）和 DBP 差异（DIA-W）。我们使用便携式全身生物阻抗谱（BIS）在血液透析前和血液透析 1-4 小时以及血液透析后 30 分钟测量了各种液体空间。在这项研究中，85 名年龄超过 18 岁且固定干体重（65.38±12.45 岁，54.18%男性，52.50%糖尿病患者）的常透析患者参与了研究。1）从血液透析后 1 小时到 30 分钟，SYS-W 患者的细胞外液（ECW）相对减少率明显高于窄透析 SBP 差异（SYS-N）患者。2）从血液透析后 1 小时到 30 分钟，DIA-W 患者的细胞内液（ICW）相对减少率明显低于窄透析 DBP 差异（DIA-N）患者。3）SYS-W 患者的 ECW 明显低于 SYS-N 患者。SYS-W 患者的特点是液体转移，ECW 的减少比 SYS-N 患者更陡峭，而 DIA-W 患者的 ICW 液体转移比 DIA-N 患者更低。
