Kamjohnjiraphunt Nutcharin, Trakarnvanich Thananda
Division of Nephrology, Department of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Ann Med Surg (Lond). 2022 Jul 31;80:104311. doi: 10.1016/j.amsu.2022.104311. eCollection 2022 Aug.
Volume overload and intradialytic hypotension (IDH) are significant complications that can increase the mortality rate in hemodialysis patients.Bioelectrical impedance analysis (BIA) has been used to estimate the optimum weight in chronic hemodialysis patients to prevent intradialytic hypotension. However, data regarding BIA for evaluating hydration in acute kidney injury patients is scarce. We reported the case series of 9 patients who used BIA in comparison with physician adjustment to prevent intradialytic hypotension in patients with acute kidney injury who received renal replacement therapy.
We randomized 9 patients with acute kidney injury (AKI) and volume overload who underwent 45 sessions of acute hemodialysis at Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand between October 2017 and February 2018 to BIA and physician -adjusted group. Volume overload was defined as a BIA value of more than>0.4. In the physician-adjusted group (control), the estimates for physical examination and fluid balance were recorded. The primary outcome was an intradialytic hypotensive episode.The secondary outcome was hemodialysis-related adverse events and other clinical outcomes. This work is fully compliant with CONSORT criteria (detailed in the supplemental file).
Among 9 patients (55.6% male, median age 65.56 years),the main underlying diseases were hypertension and diabetes mellitus. The main cause of AKI was sepsis. After randomization of overall of 45 sessions in 9 patients with AKI, the intradialytic hypotension event rate in the BIA group was significantly lower than that in the control group (5 events vs 12 events; P = 0.042). There were no differences in the rates of hemodialysis-related adverse events and other clinical outcomes between the two groups.
The use of bioelectrical impedance analysis-guided ultrafiltration in patients with acute kidney injury requiring renal replacement therapy can help reduce intradialytic hypotension.
容量超负荷和透析中低血压（IDH）是严重并发症，可增加血液透析患者的死亡率。生物电阻抗分析（BIA）已被用于估算慢性血液透析患者的最佳体重，以预防透析中低血压。然而，关于BIA用于评估急性肾损伤患者水合状态的数据却很匮乏。我们报告了9例患者的病例系列，这些患者在接受肾脏替代治疗的急性肾损伤患者中使用BIA并与医生调整方案进行比较，以预防透析中低血压。
2017年10月至2018年2月期间，我们将泰国曼谷瓦吉拉医院、那瓦明陀罗吉拉杰大学医学院的9例急性肾损伤（AKI）且容量超负荷并接受45次急性血液透析的患者随机分为BIA组和医生调整组。容量超负荷定义为BIA值大于>0.4。在医生调整组（对照组）中，记录体格检查和液体平衡的评估结果。主要结局是透析中低血压事件。次要结局是血液透析相关不良事件和其他临床结局。本研究完全符合CONSORT标准（补充文件中有详细说明）。
9例患者中（男性占55.6%，中位年龄65.56岁），主要基础疾病为高血压和糖尿病。AKI的主要病因是脓毒症。9例AKI患者共45次透析随机分组后，BIA组的透析中低血压事件发生率显著低于对照组（5次事件 vs 12次事件；P = 0.042）。两组之间血液透析相关不良事件和其他临床结局的发生率没有差异。
在需要肾脏替代治疗的急性肾损伤患者中使用生物电阻抗分析指导下的超滤可有助于降低透析中低血压的发生。
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