Movilli E, Camerini C, Viola B F, Bossini N, Strada A, Maiorca R
Division of Nephrology, School of Medicine, Spedali Civili and University of Brescia, Italy.
Am J Kidney Dis. 1997 Jul;30(1):58-63. doi: 10.1016/s0272-6386(97)90565-5.
The aim of this study was to evaluate the effects on blood volume (BV) preservation of three different profiles of dialysate sodium variation with similar intradialytic sodium balances. Ten uremic patients aged 50 +/- 11 years receiving regular bicarbonate hemodialysis for 49 +/- 57 months were studied. Each patient underwent three hemodialysis treatments with different modalities of dialysate sodium profiles: constant sodium hemodialysis (CHD), high-low sodium hemodialysis (H-LHD), and low-high sodium hemodialysis (L-HHD). In CHD, the dialysate sodium concentration was 141 mEq/L and did not change during treatment. In H-LHD and L-HHD, the dialysate sodium concentration at the start of dialysis was 160 mEq/L and 133 mEq/L, respectively, and remained constant for 60 minutes. At this time, a single-step break point of variation of dialysate sodium concentration occurred. The dialysate sodium concentration changed according to a model aimed to keep identical the amount of dialysate sodium exchanged in the three different dialysis procedures. The duration of hemodialysis, the blood flow rate, the dialysate flow rate, and the dialysis membrane were the same for all three different hemodialysis modalities. The ultrafiltration rate was kept constant during treatment. Total dialysate collection and intradialytic sodium balance were calculated for each hemodialysis session. Blood pressure and heart rate were monitored at 10-minute intervals; percent reductions of BV (%R-BV) were continuously monitored by an online optical reflection method (Hemoscan; Hospal-Dasco, Medolla, Italy). The results have shown a lower intradialytic %R-BV with H-LHD compared with L-HHD and CHD. No differences in total ultrafiltration rate, systolic and diastolic blood pressures, and heart rate were observed among the three different dialysis procedures. The total dialysate sodium collected and the intradialytic sodium balances were very similar among the three different dialysis procedures, confirming the accuracy of the precision of the sodium model used. The H-LHD sodium profile may be a useful tool in the prevention of excessive %R-BV and of dialysis intolerance episodes.
本研究的目的是评估三种具有相似透析中钠平衡的不同透析液钠变化模式对血容量（BV）保存的影响。研究了10例年龄为50±11岁、接受常规碳酸氢盐血液透析49±57个月的尿毒症患者。每位患者接受三种不同透析液钠模式的血液透析治疗：恒钠血液透析（CHD）、高低钠血液透析（H-LHD）和低高钠血液透析（L-HHD）。在CHD中，透析液钠浓度为141 mEq/L，治疗期间不变。在H-LHD和L-HHD中，透析开始时透析液钠浓度分别为160 mEq/L和133 mEq/L，并保持60分钟不变。此时，透析液钠浓度出现单步变化断点。透析液钠浓度根据一个模型进行变化，该模型旨在使三种不同透析程序中交换的透析液钠量相同。所有三种不同血液透析模式的血液透析持续时间、血流速度、透析液流速和透析膜均相同。治疗期间超滤率保持恒定。计算每次血液透析疗程的总透析液收集量和透析中钠平衡。每隔10分钟监测血压和心率；通过在线光学反射法（Hemoscan；意大利梅多拉市霍斯帕尔-达斯科公司）连续监测BV的减少百分比（%R-BV）。结果显示，与L-HHD和CHD相比，H-LHD的透析中%R-BV较低。在三种不同透析程序中，总超滤率、收缩压和舒张压以及心率均未观察到差异。三种不同透析程序中收集的总透析液钠量和透析中钠平衡非常相似，证实了所用钠模型的准确性。H-LHD钠模式可能是预防过度%R-BV和透析不耐受发作的有用工具。
