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Titolo: EFFECT OF ONLINE CONDUCTIVITY PLASMA ULTRAFILTRATE KINETIC MODELING ON CARDIOVASCULAR STABILITY OF HEMODIALYSISPATIENTS
Autore: LOCATELLI F; ANDRULLI S; DIFILIPPO S; REDAELLI B; MANGANO S; NAVINO C; ARIANO R; TAGLIAFERRI M; FIDELIO T; CORTI M; CIVARDI S; TETTA C;
 Indirizzi:
 HOSP LECCO,DIV NEPHROL & DIALYSIS,VIA GHISLANZONI 22 I22035 LECCE ITALY HOSP S GERARDO,DIV NEPHROL & DIALYSIS MONZA MILAN ITALY L GALMARINI HOSP,DIALYSIS UNIT TRADATE VARESE ITALY REG HOSP,DIV NEPHROL & DIALYSIS NOVARA ITALY HOSP INST,DIV NEPHROL & DIALYSIS CREMONA ITALY DIALYSIS UNIT TREVIGLIO ITALY DIALYSIS UNIT CIRIE TORINO ITALY BELLCO SPA,CLIN & LAB RES DEPT MIRANDOLA MODENA ITALY
 Titolo Testata:
 Kidney international
fascicolo: 4,
volume: 53,
anno: 1998,
pagine: 1052  1060
 SICI:
 00852538(1998)53:4<1052:EOOCPU>2.0.ZU;26
 Fonte:
 ISI
 Lingua:
 ENG
 Soggetto:
 DELIVERED DIALYSIS; SODIUM; TRIAL;
 Keywords:
 HYPOTENSION; DIALYSATE; ULTRAFILTRATION; KINETIC MODELING; INTRADIALYTIC CARDIAC INSTABILITY; HEMODIAFILTRATION; SODIUM BALANCE; PAIRED FILTRATION DIALYSIS;
 Tipo documento:
 Article
 Natura:
 Periodico
 Settore Disciplinare:
 Science Citation Index Expanded
 Citazioni:
 21
 Recensione:
 Indirizzi per estratti:



 Citazione:
 F. Locatelli et al., "EFFECT OF ONLINE CONDUCTIVITY PLASMA ULTRAFILTRATE KINETIC MODELING ON CARDIOVASCULAR STABILITY OF HEMODIALYSISPATIENTS", Kidney international, 53(4), 1998, pp. 10521060
Abstract
Effect of online conductivity plasma ultrafiltrate kinetic modeling on cardiovascular stability of hemodialysis patients, The aim of this multicenter, prospective, randomized crossover study was to clarify whether online conductivity ultrafiltrate kinetic modeling (treatment B), as a substitute for sodium kinetic modeling, is capable of reducing intradialytic cardiovascular instability in comparison with standardtreatment (treatment A), by reducing the sodium balance variability. Both treatments were performed by means of a modified hemodiafiltration technique. Treatment A was performed using fixed dialysate conductivity; treatment B made use of the dialysate conductivity derived from aconductivity kinetic model. in order to obtain an enddialysis ultrafiltrate conductivity at each dialysis session that was equal to the mean value determined in the same patient during the fourweek runin period. Thus, during treatment B, the expected enddialysis ultrafiltrate conductivity value of each patient should have been constant. The study was carried out according to a multicenter crossover design of 16weeks with two treatments (A or B), two sequences (1 = ABB and 2 = BAA), a runin period of four weeks (period 1, treatment A), and three consecutive experimental periods of four weeks each. Analysis of variance for a crossever design was used for the statistical analysis. Fortynine hemodialysis patients prone to intradialytic hypotension (> 25%of sessions) were enrolled from 16 participating centers, and randomly assigned to either sequence 1 (26 patients) or sequence 2 (23 patients). Six patients dropped out and four were protocol violators, which left 39 patients selected for statistical analysis. There was no difference in the average dialysate conductivity, predialysis and enddialysis plasma water ultrafiltrate conductivity or body weight between treatment A and treatment B. Thus. the observed mean sodium balance was not different and, as expected, only the intrapatient variability of enddialysis ultrafiltrate conductivity (index of sodium balance variability) was reduced (21%). During treatment A, systolic blood pressure decreased by 23 mm Hg (95% confidence intervals 21 to 24 mm Hg) at theend of dialysis with respect to the predialysis values. Treatment B reduced this intradialytic decrease (P = 0.001) with a maximum effect at the third hour of dialysis (4.4 mm Hg, 95% confidence intervals 1.9to 6.9 mm Hg, 23% less than during treatment A, P 0.0005) without anyperiod or carryover effect (P = 0.53 and 0.08, respectively). There was no treatment effect on intradialytic diastolic blood pressure (P =0.291). In conclusion, intradialytic cardiovascular stability was significantly improved by matching the interdialytic sodium load viith intradialytic sodium removal using online conductivity ultrafiltrate kinetic modeling as an alternative to sodium kinetic modeling. Although highly significant, this effect was clinically not very large. By applying this conductivity kinetic model to patients with a more variable sodium intake from one session to another, a greater benefit can be expected.
ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/07/20 alle ore 22:26:06