强化超滤对老年维持性血液透析患者高血压的影响

Intensive ultrafiltration on hypertension in elderly hemodialysis patients

目的观察通过强化超滤以进一步降低干体质量对老年维持性血液透析患者高血压的影响。方法老年维持性血液透析合并高血压患者34名分为对照组和超滤组。对照组维持常规血液透析及常规超滤。超滤组维持常规血液透析,并持续缓慢增加超滤量,降低干体质量。观察持续28周,比较2组患者干体质量和血压的变化。结果基点处2组患者干体质量基本相同[(64.81±13.26)Kg和(64.49±13.83)Kg,t=0.508,P=0.618],透析前收缩压[(155.12±13.77)mmHg和(155.47±9.92)mmHg,t=0.086,P=0.932](1mmHg=0.133Kpa)及舒张压[(78.59±11.41)mmHg和(78.71±10.96)mmHg,t=0.031,P=0.976]未见明显差异(P>0.05)。观察第28周时,2组患者干体重体质量分别为(65.56±13.75)Kg和(62.22±13.34)Kg,较前下降(0.36±1.12)Kg和(2.27±1.03)Kg,超滤组干体质量低于对照组(t=3.785,P=0.002)。透析前收缩压为(155.29±12.73)mmHg和(139.82±4.14)mmHg,分别和较前下降(0.53±4.57)mmHg和(14.29±10.55)mmHg,超滤组收缩压低于对照组(t=4.767,P=0.000)。透析前舒张压分别为(79.12±9.84)mmHg和(68.24±3.57)mmHg,分别较前下降(0.53±4.57)mmHg和(9.00±9.46)mmHg,超滤组舒张压低于对照组(t=4.298,P=0.000)。结论通过强化超滤降低干体质量,有利于老年维持性血液透析患者高血压的控制。

Objective To investigate whether additional ultrafiltration to further reduce dry body weight improves blood pressure(BP) control among elderly hemodialysis patients with hypertension.Methods Thirty-four aged maintenance hemodialysis(MHD) patients with hypertension were divided into control and ultrafiltration groups.In control group,conventional dialysis dose and ultrafiltration volume were used.In ultrafiltration group,reduction of dry body weight to a minimal tolerable level was gradually achieved by slightly increasing ultrafiltration volume.After 28 weeks,dry body weight and BP were compared between the two groups.Results In control group and ultrafiltration group at the baseline condition,dry body weight was 64.81±13.26 kg and 64.49±13.83 kg(t=0.508,P=0.618),systolic BP was 155.12±13.77 mmHg and 155.47±9.92 mmHg(t= 0.086,P=0.932),and diastolic BP was 78.59±11.41 mmHg and 78.71±10.96 mmHg(t=0.031,P= 0.976),respectively,without significant differences between the two groups.In control group and ultrafiltration group after the treatment for 28 weeks,dry body weight was 65.56±13.75 kg and 62.22±13.34 kg(reduced by 0.36±1.12 kg and 2.27±1.03 kg),systolic BP before dialysis session was 155.29±12.73 mmHg and 139.82±4.14 mmHg(reduced by 0.53±4.57 mmHg and 14.29±10.55 mmHg),and diastolic BP before dialysis session was 79.12±9.84 mmHg and 68.24±3.57 mmHg(reduced by 0.53±4.57 mmHg and 9.00±9.46 mmHg),respectively.Patients in ultrafiltration group showed more reduction in dry body weight(t=3.785,P=0.002),systolic BP(t=4.767,P=0.000),and diastolic BP(t=4.298,P=0.000) than those in control group.Conclusion The decrease of dry body weight through intensive ultrafiltration is an effective approach to improve BP control in elderly hemodialysis patients with hypertension.