血液透析患者透析液碳酸氢盐浓度过低与过高对血液动力学的影响。

IF 1.2 4区 医学 Q3 UROLOGY & NEPHROLOGY
Jonas Schandorph Kaalund Jensen, Ina Hunnerup Jørgensen, Niels Henrik Buus, Jens Dam Jensen, Christian Daugaard Peters
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引用次数: 0

摘要

导言:使用标准透析液碳酸氢盐浓度进行血液透析治疗会导致短暂的代谢性碱中毒,可能与血液动力学不稳定有关。本研究旨在对高浓度和低浓度透析液碳酸氢盐在血压、透析内血液动力学参数、正压和电解质方面进行详细比较:在一项单盲、随机对照、交叉研究中,15 名血液透析患者接受了检查。参与者在透析液碳酸氢盐浓度为 30 或 38 mmol/L 的条件下进行 4 小时血液透析,两次透析间隔一周。血液透析过程中全程监测血压,同时使用超声稀释技术(Transonic)评估心输出量、总外周阻力、每搏量和中心血容量。血液透析前和透析后测量静动脉血压:在超滤量(2.6 升)相似的情况下,与低碳酸氢盐透析液相比,高碳酸氢盐透析液透析时收缩压(SBP)的下降幅度更大;SBP 的平均值(95% 置信区间)在不同治疗间的差异为:8(-4;20)毫米汞柱:8(-4;20)毫米汞柱(血液透析结束时)和7(0;15)毫米汞柱(血液透析后)。与低碳酸氢盐透析相比,在高碳酸氢盐透析期间,卒中量明显减少,而总外周阻力明显增加,治疗间平均差异为平均治疗差异为:卒中量:12 (1; 23) mL;总外周阻力:-2.9 (-5.3; -0.5) mmHg/(L/min)。与低碳酸氢盐透析液相比,高碳酸氢盐透析液的心输出量下降幅度更大,治疗间平均差异为 0.7 (0.0; 1.4) 升/分钟。高浓度透析液碳酸氢盐会导致碱中毒、低钙血症和血浆钾降低,而低浓度透析液碳酸氢盐则会使患者保持正常钙血症和正常 pH 值。讨论:讨论:与低碳酸氢盐透析相比,使用高碳酸氢盐透析与低钙血症、碱中毒和更明显的低钾血症有关。在使用超滤的血液透析过程中,低碳酸氢盐透析液比高碳酸氢盐透析液能更好地保持血压、每搏量和心输出量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients

Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients

Introduction

Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes.

Methods

Fifteen hemodialysis patients were examined in a single-blind, randomized, controlled, crossover study. Participants underwent a 4-h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre- and post-hemodialysis.

Findings

With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post-hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly.

Discussion

The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate.

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来源期刊
Hemodialysis International
Hemodialysis International UROLOGY & NEPHROLOGY-
CiteScore
2.50
自引率
0.00%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.
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