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Titolo:
EFFECT OF ONLINE CONDUCTIVITY PLASMA ULTRAFILTRATE KINETIC MODELING ON CARDIOVASCULAR STABILITY OF HEMODIALYSIS-PATIENTS
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 I-22035 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:
0085-2538(1998)53:4<1052:EOOCPU>2.0.ZU;2-6
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 HEMODIALYSIS-PATIENTS", Kidney international, 53(4), 1998, pp. 1052-1060

Abstract

Effect of on-line conductivity plasma ultrafiltrate kinetic modeling on cardiovascular stability of hemodialysis patients, The aim of this multicenter, prospective, randomized cross-over study was to clarify whether on-line 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 end-dialysis ultrafiltrate conductivity at each dialysis session that was equal to the mean value determined in the same patient during the four-week run-in period. Thus, during treatment B, the expected end-dialysis ultrafiltrate conductivity value of each patient should have been constant. The study was carried out according to a multicenter cross-over design of 16weeks with two treatments (A or B), two sequences (1 = ABB and 2 = BAA), a run-in period of four weeks (period 1, treatment A), and three consecutive experimental periods of four weeks each. Analysis of variance for a cross-ever design was used for the statistical analysis. Forty-nine 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 end-dialysis 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 intra-patient variability of end-dialysis 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 pre-dialysis 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 carry-over 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 on-line 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.

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Documento generato il 02/07/20 alle ore 22:26:06