轻度下调血液透析液钠浓度可有效降低处于干体重的行维持性血液透析的终末期肾病伴高血压患者血压和血钠:多中心、自身对照研究  

Mildly Lowering Dialysate Sodium Concentration May Effectively Reduce the Blood Pressure and Plasma Sodium in End-stage Renal Disease Patients with Hypertension,Dry Weight,and Maintenance Hemodialysis:a Multicenter,Self-controlled Study

作　　者：张寅[1] 周亦伦[1] 赵海丹 申玉兰 马云伶 郭增玉 周培一[6] 李红 李建军[8] 丁霞 龚勇[1] 刘婧 ZHANG Yin;ZHOU Yilun;ZHAO Haidan;SHEN Yulan;MA Yunling;GUO Zengyu;ZHOU Peiyi;LI Hong;LI Jianjun;DING Xia;GONG Yong;LIU Jing(Department of Nephrology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Nephrology,Peking University Shougang Hospital,Beijing 100144,China;Department of Nephrology,Beijing Miyun District Hospital,Beijing 101500,China;Department of Nephrology,Beijing Yanqing District Hospital,Beijing 102100,China;Department of Nephrology,Beijing Friendship Hospital Pinggu Hospital,Beijing 101200,China;Department of Nephrology,Beijing Daxing District People's Hospital,Beijing 102600,China;Hemodialysis Room,Beijing Chaoyang Integrative Medicine Emergency Medical Center,Beijing 100022,China;Department of Nephrology,Tongzhou Branch,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 101121,China)

机构地区：[1]首都医科大学附属北京天坛医院肾内科,北京市100070 [2]北京大学首钢医院肾内科,北京市100144 [3]北京市密云区医院肾内科,101500 [4]北京市延庆区医院肾内科,102100 [5]北京友谊医院平谷医院肾内科,北京市101200 [6]北京市大兴区人民医院肾内科,102600 [7]北京市朝阳中西医结合急诊抢救中心血液透析室,100022 [8]北京中医药大学东直门医院通州院区肾内科,北京市101121

出　　处：《中国全科医学》2020年第36期4585-4589,共5页Chinese General Practice

基　　金：北京市卫生和计划生育委员会北京市卫生与健康科技成果和适宜技术推广项目(2018-TF-32);北京市医院管理中心“登峰”计划专项(DFL20190502);北京市医院管理局“扬帆计划”重点医学专业资助项目(ZYLX201820)。

摘　　要：背景高血压是终末期肾病维持性血液透析患者常见并发症之一,研究表明降低血液透析液钠浓度可改善终末期肾病维持性血液透析伴高血压患者水钠负荷并降低其血压,但多数研究样本量较小,降低血液透析液钠浓度的临床意义尚存在争议。目的通过扩大样本量而进一步证实降低血液透析液钠浓度对处于干体重的行维持性血液透析的终末期肾病伴高血压患者血压、血钠的影响,并验证其安全性。方法本研究为多中心、自身对照研究,共选取2018年9—11月在北京市7家血液净化中心行维持性血液透析的终末期肾病伴高血压患者154例,2018年12月开始将其血液透析液钠浓度调整至138 mmol/L并维持1个月(干预前),2019年1月开始下调其血液透析液钠浓度至136 mmol/L并维持4个月(干预后)。比较所有患者干预前1个月最后1周、干预后1周血液透析前血红蛋白、血白蛋白、血钙、血磷、甲状旁腺激素、收缩压、舒张压及血液透析前后血钠、血液透析间期干体重增长数,记录所有患者使用降压药物种数及血液透析过程中不良事件发生情况。结果154例患者干预后血液透析前平均血红蛋白、血白蛋白、血钙、血磷、甲状旁腺激素与干预前比较,差异无统计学意义(P>0.05),干预后血液透析前后平均血钠、血液透析间期干体重增长数、血液透析前收缩压及舒张压、使用降压药物种数较干预前降低(P<0.05)。154例患者干预前后血液透析过程中低血压、肌肉痉挛发生率比较,差异无统计学意义(P>0.05)。结论轻度下调血液透析液钠浓度可有效降低处于干体重的行维持性血液透析的终末期肾病伴高血压患者血压、血钠,且安全性较高,宜于在基层血液透析机构推广应用。Background Hypertension is one of the common complications in end-stage renal disease patients undergoing maintenance hemodialysis.Previous studies have shown that lowering dialysate sodium concentration could adjust the water and sodium retention and thus reduce the blood pressure in end-stage renal disease patients with hypertension and maintenance hemodialysis,however,most of these studies have a small sample size,and the clinical significance of lowering dialysate sodium concentration is still controversial.Objective To verify the effect and safety of lowering dialysate sodium concentration for controlling blood pressure and plasma sodium in a large sample of end-stage renal disease patients with hypertension,dry weight and maintenance hemodialysis.Methods In this multicenter,self-controlled study,154 end-stage renal disease patients with hypertension and maintenance hemodialysis from seven blood purifying centers in Beijing were enrolled between September and November 2018.The dialysate sodium concentration of them was adjusted to 138 mmol/L on December 1,2018 and maintained to December 31,2018(defined as pre-intervention),then adjusted to 136 mmol/L on January 1,2019 and maintained to April 30, 2019(defined as post-intervention).Pre-hemodialysis plasma hemoglobin,albumin,calcium,phosphorus,parathormone,systolic and diastolic blood pressure,pre-and post-hemodialysis plasma sodium measured in the last week of December 2018 and the first week of May 2019 were compared.Interdialytic dry weight gain,kinds of antihypertensive drugs being used and incidence of adverse events during hemodialysis were recorded.Results The average preand post-intervention pre-hemodialysis plasma hemoglobin,albumin,calcium,phosphorus and parathormone in all cases were not significantly different(P>0.05),but the average pre-and post-hemodialysis plasma sodium,pre-hemodialysis systolic and diastolic blood pressure,and interdialytic dry weight gain as well as the kinds of antihypertensive drugs being used showed significant reduction aft

关 键 词：高血压 血液透析 血液透析液 钠 血压 多中心研究 

分 类 号：R544.1[医药卫生—心血管疾病] R459.5[医药卫生—内科学]