Ramdeen G, Tzamaloukas A H, Malhotra D, Leger A, Murata G H
Albuquerque Veterans Affairs Medical Center, Department of Medicine, University of New Mexico School of Medicine, 87108, USA.
ASAIO J. 1998 Nov-Dec;44(6):812-7. doi: 10.1097/00002480-199811000-00009.
Whether salt or water intake is the primary cause of interdialytic weight gain (deltaW) has important implication for the design of measures to prevent large deltaW. In 17 hemodialysis patients dialyzed against a bath containing 140 mmol/L of sodium, monthly predialysis serum sodium was compared with post dialysis serum sodium. A decrease in serum sodium in the interdialytic period would indicate that primary water consumption accounts for at least part of the deltaW. Interdialytic sodium intake, isotonic fluid gain (deltaW(isotonic)) and net pure water gain (deltaWH2O) were calculated by balance formulae. Serum sodium concentration was corrected in diabetic subjects to the value corresponding to euglycemia (100 mg/dl). Estimated interdialytic sodium intake was compared with the prescribed sodium intake and, in seven subjects, to sodium intake estimated from dietary records. Results for nondiabetic subjects (N = 9): [Na]post 139.3 +/- 1.9 mmol/L, [Na]pre 140.1 +/- 2.1 mmol/L (NS), deltaW 1.15 +/- 0.55 L/24 hr, deltaW(isotonic) 1.33 +/- 0.57 L/24 hr, deltaWH2O -0.20 +/- 0.58 L/24 hr, estimated sodium intake 206 +/- 75 mmol/24 hr, prescribed sodium intake 121 +/- 29 mmol/24 hr (p = 0.028). Results for diabetic subjects (N = 7): [Na]post 140.1 +/- 2.5 mmol/L, [Na]pre 137.7 +/- 3.1 mmol/L (p < 0.01), deltaW 1.26 +/- 0.38 L/24 hr, deltaW(isotonic) 0.59 +/- 0.63 L/24 hr, deltaWH2O 0.66 +/- 0.39 L/24 hr, estimated sodium intake 160 +/- 81 mmol/24 hr, prescribed sodium intake 124 +/- 30 mmol/24 hr (NS), glycosylated hemoglobin 9.7 +/- 2.8% (normal, 4.1-5.7%). In seven subjects, estimates of sodium intake from balance formulae (233 +/- 113 mmol/24 hr) were not different from estimates from dietary records (212 +/- 87 mmol/24 hr). Sodium intake accounted for all the interdialytic weight gain in nondiabetic subjects. In diabetic patients, only approximately half of the interdialytic weight gain was accounted for by sodium intake. The other half was due to pure water gain, probably caused by hyperglycemia.
盐摄入还是水摄入是透析间期体重增加（ΔW）的主要原因，这对于预防大幅ΔW的措施设计具有重要意义。在17例使用含140 mmol/L钠的透析液进行透析的血液透析患者中，比较了每月透析前血清钠与透析后血清钠。透析间期血清钠降低表明主要的水消耗至少是部分ΔW的原因。通过平衡公式计算透析间期钠摄入量、等渗液增加量（ΔW（等渗））和纯水平衡增加量（ΔWH2O）。糖尿病患者的血清钠浓度校正为对应于血糖正常（100 mg/dl）的值。将估计的透析间期钠摄入量与规定的钠摄入量进行比较，并在7例患者中与根据饮食记录估计的钠摄入量进行比较。非糖尿病患者（N = 9）的结果：透析后[Na] 139.3±1.9 mmol/L，透析前[Na] 140.1±2.1 mmol/L（无显著差异），ΔW 1.15±0.55 L/24小时，ΔW（等渗）1.33±0.57 L/24小时，ΔWH2O -0.20±0.58 L/24小时，估计钠摄入量206±75 mmol/24小时，规定钠摄入量为每日121±29 mmol/24小时（p = 0.028）。糖尿病患者（N = 7）的结果：透析后[Na] 140.1±2.5 mmol/L，透析前[Na] 137.7±3.1 mmol/L（p < 0.01），ΔW 1.26±0.38 L/24小时，ΔW（等渗）0.59±0.63 L/24小时，ΔWH2O 0.66±0.39 L/24小时，估计钠摄入量160±81 mmol/24小时，规定钠摄入量为每日124±30 mmol/24小时（无显著差异），糖化血红蛋白9.7±2.8%（正常，4.1 - 5.7%）。在7例患者中，根据平衡公式估计的钠摄入量（233±113 mmol/24小时）与根据饮食记录估计的钠摄入量（212±87 mmol/24小时）无差异。钠摄入占非糖尿病患者透析间期体重增加的全部原因。在糖尿病患者中，透析间期体重增加只有大约一半是由钠摄入引起的。另一半是由于纯水增加，可能是由高血糖导致的。
