Medical College of Yangzhou University, Yangzhou, PR China.
Department of Cardiology, Friendliness Hospital Yangzhou, Yangzhou, PR China.
Acta Cardiol. 2024 Jul;79(5):599-604. doi: 10.1080/00015385.2023.2268426. Epub 2023 Oct 31.
To evaluate the efficacy and safety of ultrafiltration (UF) combined with haemodialysis (HD) sequential therapy in patients with intradialytic hypotension (IDH) and water retention.
A total of 53 uraemia patients with IDH who could not tolerate dehydration and significant water and sodium retention (net weight gain of more than 4 kg) were randomly divided into control group (28 cases) and treatment group (25 cases). After adjusting dialysis parameters (blood pump speed and excessive filtration), HD was tried again in the control group, and UF combined with HD was given sequential treatment in the treatment group. Outcome measures included efficacy measures (duration of treatment, total water removal, weight loss, dyspnoea score and left ventricular ejection fraction) and safety measures (heart rate, blood pressure, IDH incidence, bleeding and thromboembolic events).
In terms of efficacy indicators, In the sequential treatment group, the duration of treatment (740 ± 168 min . 380 ± 94 min, < 0.05), total water removal (5280 ± 968 mL 2980 ± 765 mL, < 0.05) and the weight loss (2756 ± 537 g . 1421 ± 362 g, < 0.05) was significantly higher than that of control group. Postoperative dyspnoea score (1.92 ± 0.400 3.32 ± 0.476, < 0.05), left ventricular ejection fraction (LVEF; 49.25 ± 3.76 56.46 ± 4.42, < 0.05) was significantly improved compared with that before treatment, and the difference was statistically significant. In control group, dyspnoea score (1.89 ± 0.416 1.82 ± 0.390, > 0.05) and left ventricular ejection fraction (49.04 ± 6.72 48.61 ± 7.12, > 0.05) were slightly improved after treatment, but there was no statistical significance. In terms of safety indicators, patients in the control group were prone to significant blood pressure fluctuation during treatment, and the incidence of IDH was significantly higher than that in the treatment group (75% 0%, < 0.01), the difference was statistically significant, while the other safety indicators (heart rate change, bleeding and thromboembolic events) showed no statistically significant difference between the two groups.
Compared with conventional HD, UF combined with HD can safely and effectively reduce water retention in patients with uraemia while avoiding IDH.
评估超滤（UF）联合血液透析（HD）序贯疗法治疗透析中低血压（IDH）伴水潴留患者的疗效和安全性。
选择 53 例不能耐受脱水且存在明显水钠潴留（净体重增加超过 4kg）的 IDH 尿毒症患者，随机分为对照组（28 例）和治疗组（25 例）。对照组在调整透析参数（血泵速度和超滤量）后再次进行 HD，治疗组给予 UF 联合 HD 序贯治疗。观察指标包括疗效指标（治疗时间、总脱水量、体重减轻量、呼吸困难评分和左心室射血分数）和安全性指标（心率、血压、IDH 发生率、出血和血栓栓塞事件）。
在疗效指标方面，序贯治疗组的治疗时间（740±168min vs. 380±94min， < 0.05）、总脱水量（5280±968mL vs. 2980±765mL， < 0.05）和体重减轻量（2756±537g vs. 1421±362g， < 0.05）均显著高于对照组。治疗后，序贯治疗组的呼吸困难评分（1.92±0.400 vs. 3.32±0.476， < 0.05）、左心室射血分数（LVEF；49.25±3.76 vs. 56.46±4.42， < 0.05）均显著改善，差异均有统计学意义。对照组治疗后呼吸困难评分（1.89±0.416 vs. 1.82±0.390， > 0.05）和左心室射血分数（49.04±6.72 vs. 48.61±7.12， > 0.05）略有改善，但差异无统计学意义。在安全性指标方面，对照组患者在治疗过程中血压波动明显，IDH 发生率显著高于治疗组（75% vs. 0%， < 0.01），差异有统计学意义，而其他安全性指标（心率变化、出血和血栓栓塞事件）两组间差异无统计学意义。
与常规 HD 相比，UF 联合 HD 序贯治疗可安全有效地减轻尿毒症患者的水潴留，同时避免 IDH 的发生。
