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首页> 外文期刊>Artificial Organs >Dialysis and Patient Factors Which Determine Convective Volume Exchange in Patients Treated by Postdilution Online Hemodiafiltration
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Dialysis and Patient Factors Which Determine Convective Volume Exchange in Patients Treated by Postdilution Online Hemodiafiltration

机译：透析和确定在线稀释后在线血液透析滤过患者对流容积交换的患者因素

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Recent reports suggest a survival advantage for dialysis patients treated by postdilutional online hemodiafiltration (OL-HDF) who achieve higher volume convective exchanges. As such, the factors associated with achieving higher convective volume exchange were determined. The convective exchange volumes during the midweek OL-HDF session in a cohort of 653 patients with corresponding bio-impedance measurements of volume status and sessional electronic records were audited. Mean patient age was 64.9+/-14.9 years, 65.3% male, 47.7% diabetes, with 81.6% dialyzing using fistula access. Sessional substitution volume exchanged was 17.063.5 L (83.8+/-13.9 mL/min), with a filtration fraction of 23.3+/-4.6%, sessional time of 3.8+/-0.5 h, and blood flow 321+/-28 mL/min. As expected, convection exchange volume achieved was associated with sessional time (beta 3.24, P< 0.001), blood flow (beta 0.03, P< 0.001), dialysate flow (beta 0.03, P< 0.001), but also patient factors: postsessional intracellular water (ICW) (beta 0.07, P<0.002), and serum albumin (beta 0.71, P < 0.011). In addition convective exchange was lower for diabetics (16.6+/-3.0 vs. 17.3+/-3.8 L, P< 0.01), and for patients with higher Davies co-morbidity grades (16.6+/-2.8 vs. 17.0+/-3.6 vs. 17.9+/-4.0 L), P=0.01 respectively. As expected the convective volume exchanged with OL-HDF was associated with sessional time and blood and dialysate flows. However, the convective volume exchange achieved was also associated with patient factors, including ICW, which is related to body cell mass and also co-morbidity. Although some center practices can be modified to increase convective exchange, patient factors are not so readily remediable. As such, highly comorbid patients may not be able to achieve the higher volume convective exchanges reported to be associated with improved patient survival.
机译：最近的报告表明，通过稀释后在线血液透析滤过（OL-HDF）治疗的透析患者在实现对流交换方面具有更大的生存优势。这样，确定了与实现更高对流体积交换相关的因素。审核了653名患者的OL-HDF周中期间的对流交换量，并对其容量状态和会话电子记录进行了相应的生物阻抗测量。平均患者年龄为64.9 +/- 14.9岁，男性为65.3％，糖尿病为47.7％，通过瘘管透析的患者为81.6％。交换的会话替代量为17.063.5 L（83.8 +/- 13.9 mL / min），过滤率为23.3 +/- 4.6％，会话时间为3.8 +/- 0.5 h，血流为321 +/- 28毫升/分钟如预期的那样，对流交换量与会话时间（β3.24，P <0.001），血流量（β0.03，P <0.001），透析液流量（β0.03，P <0.001），以及患者因素有关：会后细胞内水（ICW）（β0.07，P <0.002）和血清白蛋白（β0.71，P <0.011）。此外，糖尿病患者的对流交换率较低（16.6 +/- 3.0 vs. 17.3 +/- 3.8 L，P <0.01），戴维斯合并症等级较高的患者（16.6 +/- 2.8 vs. 17.0 +/-） 3.6 vs. 17.9 +/- 4.0 L），分别为P = 0.01。正如预期的那样，与OL-HDF交换的对流体积与会话时间，血液和透析液流量相关。但是，对流体积交换也与患者因素有关，包括ICW，ICW与体细胞质量以及合并症有关。尽管可以修改某些中心做法以增加对流交换，但患者因素却难以补救。因此，高度合并症患者可能无法实现更高的对流交换率，据报道这与患者生存期延长有关。

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