关键词: 左心室功能, 低温透析, 低血压

Abstract:

Objective This study evaluated the dialysate of lower temperature on regional left ventricular function in intradialytic hypotension patients. Methods To understand the development of dialysis-induced left ventricular regional wall motion abnormalities (RWMA), we randomly assigned 20 patients, who were at adequate dialysis for more than 6 months and showed repeated intradialytic hypotension episodes in recent months, to use dialysate for hemodialysis at the temperature of 370C (HD37) or 350C (HD35). During every dialysis, echocardiography was performed before dialysis, at the end of dialysis and after the dialysis for 30 minutes. Blood pressure and hemodynamic variables were monitored as well. Score of subjective feeling relating to the lower temperature was recorded. The treatment to the 2 groups of patients was switched every 2 weeks, i.e., patients treated with HD37 for 2 weeks were then switched to receive HD35 for 2 weeks, and vice versa. Routine blood examination and blood biochemistry were conducted before the dialysis and after the dialysis for 2 weeks. Result No differences in biochemical parameters were found between patients treated with HD37 and those with HD35. Patients treated with HD35 had higher mean blood pressure (P<0.001), less heart rate (P<0.001) and lower incidence of symptomatic or asymptomatic intradialytic hypotension (P<0.001), as compared with these variables in patients treated with HD37. Left ventricular short axis fractional shortening (P<0.001) and ejection fraction (P<0.001) were higher, the presence of RWMA was less (P<0.001), and the ratio of recovery from RWMA was greater (P<0.001) in patients using HD35 than those using HD37. The number of patients complaining of cold feeling was the same in patients treated with HD35 and in those with HD37 (P>0.05). Conclusion Our results show that dialysis-induced regional left ventricular dysfunction can be improved by using dialysate of lower temperature.

Key words: Cool dialysate, Hypotension