{"title":"透析过程中相对血容量的变化是由超滤率和透析前血液检测值决定的。","authors":"Tomoyuki Tanaka, Yoshifumi Kawakubo, Takeshi Shigematsu, Haruhiko Nishimura","doi":"10.1159/000536073","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Continuous monitoring of relative blood volume (percentage BV) in hemodialysis (HD) is critical for determining dry weight and preventing intradialytic hypotension. However, the cause of the BV variation remains unknown. This research aimed to examine factors that influence the percentage BV.</p><p><strong>Methods: </strong>We devised a formula based on coefficients (\"a,\" \"τ,\" and \"b\") to predict changes in percentage BV. \"a\" denotes a significant decrease in percentage BV in the early stages of HD. \"τ\" represents the transition from early to late phase of HD. \"b\" denotes the slope of the decrease in percentage BV in the late phase of HD. We measured the percentage BV in 18 patients with end-stage renal disease. The coefficients were estimated by fitting experimental data from patients using a least squares optimization algorithm. A correlation analysis of these parameters and patient predialysis data was performed.</p><p><strong>Results: </strong>Ultrafiltration rate (UFR) was found to be negatively correlated with \"b\" (r = -0.851, p < 0.01). However, UFR was not significantly related to \"a.\" Predialysis serum total protein level was negatively correlated with \"a\" (r = -0.531, p = 0.042). Predialysis serum albumin and predialysis sodium were not significantly correlated with \"a\" and \"τ.\" Plasma osmolarity did not have a significant relationship with \"a\" and \"τ.\"</p><p><strong>Discussion/conclusion: </strong>UFR influenced the decrease in percentage BV in the late phase but did not influence the decrease of percentage BV in the early phase. \"a\" was associated with predialysis serum total protein level but not with plasma osmolality or predialysis sodium. This implies that colloid oncotic pressure is important for plasma refilling immediately after dialysis begins. During the change of percentage BV, the decrease in the early phase of dialysis was not related to UFR, but related to other parameters, especially predialysis total protein level. A decrease in the late phase of dialysis is related to UFR.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Changes in Relative Blood Volume during Dialysis Are Characterized by Ultrafiltration Rate and Predialysis Blood Test Values.\",\"authors\":\"Tomoyuki Tanaka, Yoshifumi Kawakubo, Takeshi Shigematsu, Haruhiko Nishimura\",\"doi\":\"10.1159/000536073\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Continuous monitoring of relative blood volume (percentage BV) in hemodialysis (HD) is critical for determining dry weight and preventing intradialytic hypotension. However, the cause of the BV variation remains unknown. This research aimed to examine factors that influence the percentage BV.</p><p><strong>Methods: </strong>We devised a formula based on coefficients (\\\"a,\\\" \\\"τ,\\\" and \\\"b\\\") to predict changes in percentage BV. \\\"a\\\" denotes a significant decrease in percentage BV in the early stages of HD. \\\"τ\\\" represents the transition from early to late phase of HD. \\\"b\\\" denotes the slope of the decrease in percentage BV in the late phase of HD. We measured the percentage BV in 18 patients with end-stage renal disease. The coefficients were estimated by fitting experimental data from patients using a least squares optimization algorithm. A correlation analysis of these parameters and patient predialysis data was performed.</p><p><strong>Results: </strong>Ultrafiltration rate (UFR) was found to be negatively correlated with \\\"b\\\" (r = -0.851, p < 0.01). However, UFR was not significantly related to \\\"a.\\\" Predialysis serum total protein level was negatively correlated with \\\"a\\\" (r = -0.531, p = 0.042). Predialysis serum albumin and predialysis sodium were not significantly correlated with \\\"a\\\" and \\\"τ.\\\" Plasma osmolarity did not have a significant relationship with \\\"a\\\" and \\\"τ.\\\"</p><p><strong>Discussion/conclusion: </strong>UFR influenced the decrease in percentage BV in the late phase but did not influence the decrease of percentage BV in the early phase. \\\"a\\\" was associated with predialysis serum total protein level but not with plasma osmolality or predialysis sodium. This implies that colloid oncotic pressure is important for plasma refilling immediately after dialysis begins. During the change of percentage BV, the decrease in the early phase of dialysis was not related to UFR, but related to other parameters, especially predialysis total protein level. A decrease in the late phase of dialysis is related to UFR.</p>\",\"PeriodicalId\":8953,\"journal\":{\"name\":\"Blood Purification\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Blood Purification\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000536073\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/4 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Purification","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000536073","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/4 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介：持续监测血液透析（HD）中的相对血容量（BV 百分比）对于确定干体重和预防透析内低血压至关重要。然而，血容量变化的原因仍然不明。本研究旨在探讨影响血容量百分比的因素：我们设计了一个基于系数（"a"、"τ "和 "b"）的公式来预测血容量百分比的变化。a "表示 HD 早期 BV 百分比显著下降。τ "代表从 HD 早期到晚期的过渡。b "表示 HD 晚期 BV 百分比下降的斜率。我们测量了 18 位终末期肾病患者的血压百分比。这些系数是通过使用最小二乘优化算法对患者的实验数据进行拟合而估算出来的。对这些参数和患者透析前数据进行了相关分析：结果：发现超滤率（UFR）与 "b "呈负相关（r = -0.851，p < 0.01）。然而，超滤率与 "a "无明显关系。透析前血清总蛋白水平与 "a "呈负相关（r = -0.531，p = 0.042）。透析前血清白蛋白和透析前血钠与 "a "和 "τ "无明显相关性。血浆渗透压与 "a "和 "τ "无明显关系：讨论/结论：UFR 影响晚期 BV 百分比的下降，但不影响早期 BV 百分比的下降。a "与透析前血清总蛋白水平有关，但与血浆渗透压或透析前血钠无关。这意味着，胶体渗透压对透析开始后立即进行的血浆再充盈非常重要。在 BV 百分比的变化过程中，透析早期的下降与 UFR 无关，而与其他参数有关，尤其是透析前的总蛋白水平。透析晚期的下降与 UFR 有关。
The Changes in Relative Blood Volume during Dialysis Are Characterized by Ultrafiltration Rate and Predialysis Blood Test Values.
Introduction: Continuous monitoring of relative blood volume (percentage BV) in hemodialysis (HD) is critical for determining dry weight and preventing intradialytic hypotension. However, the cause of the BV variation remains unknown. This research aimed to examine factors that influence the percentage BV.
Methods: We devised a formula based on coefficients ("a," "τ," and "b") to predict changes in percentage BV. "a" denotes a significant decrease in percentage BV in the early stages of HD. "τ" represents the transition from early to late phase of HD. "b" denotes the slope of the decrease in percentage BV in the late phase of HD. We measured the percentage BV in 18 patients with end-stage renal disease. The coefficients were estimated by fitting experimental data from patients using a least squares optimization algorithm. A correlation analysis of these parameters and patient predialysis data was performed.
Results: Ultrafiltration rate (UFR) was found to be negatively correlated with "b" (r = -0.851, p < 0.01). However, UFR was not significantly related to "a." Predialysis serum total protein level was negatively correlated with "a" (r = -0.531, p = 0.042). Predialysis serum albumin and predialysis sodium were not significantly correlated with "a" and "τ." Plasma osmolarity did not have a significant relationship with "a" and "τ."
Discussion/conclusion: UFR influenced the decrease in percentage BV in the late phase but did not influence the decrease of percentage BV in the early phase. "a" was associated with predialysis serum total protein level but not with plasma osmolality or predialysis sodium. This implies that colloid oncotic pressure is important for plasma refilling immediately after dialysis begins. During the change of percentage BV, the decrease in the early phase of dialysis was not related to UFR, but related to other parameters, especially predialysis total protein level. A decrease in the late phase of dialysis is related to UFR.
期刊介绍：
Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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