Sadowski R H, Allred E N, Jabs K
Division of Nephrology, Children's Hospital and Harvard Medical School, Boston, MA.
J Am Soc Nephrol. 1993 Nov;4(5):1192-8. doi: 10.1681/ASN.V451192.
Despite advances in the delivery of hemodialysis, significant dialytic morbidity persists. Sodium modeling in older adults has been shown to decrease some dialytic symptoms, but clear benefits in young patients without coexisting diabetes or advanced cardiovascular disease have not been shown. The effects of sodium modeling were evaluated in 16 adolescent and young adult hemodialysis patients (16 to 32 yr of age) treated with conventional hemodialysis for a median of 11.5 months. The 8-wk study was divided into four 2-wk blocks. During each block, one of three sodium programs or a constant (control) dialysate sodium of 138 mEq/L was used. During each sodium program, the initial dialysate sodium of 148 mEq/L was decreased by an exponential, linear, or step program to 138 mEq/L. Treatments with sodium modeling were significantly better than those with constant sodium dialysate. When all sodium programs were grouped and compared with constant dialysate sodium, the odds of improvement in dialytic cramps, headaches, and nausea were 1.8, 2.1, and 3.9, respectively (P < 0.05). Sodium modeling also significantly decreased the frequency of postdialysis hypotension and interdialytic fatigue, dizziness, and muscle cramping (P < 0.05). No differences were seen among the sodium protocols in the incidence of symptomatic hypotension, the amount of normal saline administered, the degree of hemo-concentration during treatments, or the decrease in serum osmolality. There was no increase in pretreatment or posttreatment serum sodium concentrations, interdialytic thirst, weight gain, or hypertension. Sodium modeling dramatically decreases both intradialytic and interdialytic morbidity in young hemodialysis patients. There was no increase in adverse events associated with sodium modeling.
尽管血液透析技术有所进步，但严重的透析相关并发症仍然存在。研究表明，老年患者采用钠模型可减轻一些透析症状，但对于无糖尿病或晚期心血管疾病的年轻患者，尚未显示出明显益处。本研究评估了16例接受常规血液透析的青少年及青年成人血液透析患者（年龄16至32岁），中位透析时间为11.5个月。这项为期8周的研究分为四个2周阶段。在每个阶段，采用三种钠方案之一或138 mEq/L的恒定（对照）透析液钠浓度。在每个钠方案中，初始透析液钠浓度148 mEq/L通过指数、线性或阶梯方案降至138 mEq/L。采用钠模型的治疗效果明显优于使用恒定钠透析液的治疗。当将所有钠方案分组并与恒定透析液钠浓度进行比较时，透析性痉挛、头痛和恶心改善的几率分别为1.8、2.1和3.9（P<0.05）。钠模型还显著降低了透析后低血压以及透析间期疲劳、头晕和肌肉痉挛的发生率（P<0.05）。在症状性低血压的发生率、生理盐水的使用量、治疗期间的血液浓缩程度或血清渗透压降低方面，各钠方案之间未见差异。治疗前或治疗后血清钠浓度、透析间期口渴、体重增加或高血压均未增加。钠模型显著降低了年轻血液透析患者透析期间和透析间期的并发症发生率。与钠模型相关的不良事件并未增加。
