Lins R L, Elseviers M, Rogiers P, Van Hoeyweghen R J, De Raedt H, Zachee P, Daelemans R A
Department of Nephrology-Hypertension, A. Z. Stuivenberg, Antwerpen, Belgium.
Clin Nephrol. 1997 Jul;48(1):29-33.
To evaluate the relation between total body water and dialysis related hypertension.
Thirty stable chronic hemodialysis patients were studied. Twenty-four-hour ambulatory blood pressure on the day before dialysis, blood pressure before and after dialysis, weight gain, ultrafiltration and total body water were determined. Total body water was measured by body impedance analysis and expressed as percentage of dry weight (TBW %). Ambulatory blood pressure recordings were defined as hypertensive when the blood pressure load (% of readings above 140/90 mmHg) was more than 40%.
Patients, classified as normotensive (n = 11) or hypertensive (n = 19), based on 24-hour blood pressure measurements, had significantly different TBW % (54.7 +/- 5.3 vs. 58.9 +/- 4.6%, p = 0.046). Ambulatory blood pressure and postdialysis blood pressure, but not predialysis blood pressure, were significantly correlated with TBW %. Acute volume changes, as reflected by interdialytic weight gain and ultrafiltration did not correlate with TBW %. These changes correlated weakly with predialysis blood pressure. Multivariate analysis showed that only TBW % and antihypertensive medication had an independent influence on 24-hour blood pressure measurements. We conclude that 24-hour blood pressure and blood pressure after dialysis are better related to total body water than blood pressure before dialysis, which was however weakly related to the acute volume overload, induced by interdialytic weight gain. We hypothesize that this could be the result of a more important chronic volume overload leading to an increase in systemic vascular resistance. On the contrary the acute but less important changes in extracellular volume between dialyses cause no hypertension after dialysis and no sustained hypertension over 24 hours, but only in some cases a temporary increase in the blood pressure just before dialysis. This volume overload can be easily determined by measurement of total body water by bioelectrical impedance analysis.
评估总体水与透析相关性高血压之间的关系。
对30例稳定的慢性血液透析患者进行研究。测定透析前的24小时动态血压、透析前后的血压、体重增加量、超滤量和总体水。通过人体阻抗分析测量总体水，并以干体重的百分比（TBW%）表示。当血压负荷（血压读数高于140/90 mmHg的百分比）超过40%时，动态血压记录被定义为高血压。
根据24小时血压测量结果，分为血压正常组（n = 11）和高血压组（n = 19）的患者，其TBW%有显著差异（54.7 +/- 5.3对58.9 +/- 4.6%，p = 0.046）。动态血压和透析后血压与TBW%显著相关，但透析前血压与TBW%无显著相关性。透析间期体重增加和超滤所反映的急性容量变化与TBW%无相关性。这些变化与透析前血压的相关性较弱。多因素分析表明，只有TBW%和抗高血压药物对24小时血压测量有独立影响。我们得出结论，24小时血压和透析后血压与总体水的关系比透析前血压更好，而透析前血压与透析间期体重增加引起的急性容量超负荷的关系较弱。我们推测，这可能是由于更重要的慢性容量超负荷导致全身血管阻力增加的结果。相反，透析期间细胞外液的急性但不太重要的变化在透析后不会导致高血压，在24小时内也不会导致持续性高血压，而仅在某些情况下会在透析前导致血压暂时升高。这种容量超负荷可以通过生物电阻抗分析测量总体水来轻松确定。
