Effect of various blood purification methods on intradialytic hypotension patients from the change of arterial structure and hemodynamic mechanics

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1 J J J. J J J MHD IDH IDH 30 HD HDF + HD HP P PTH C - hs - CRP IMT Vmax Vmin RI 1HDF + HD HP + HD P < HDF + HD HP + HD P PTH Hs - CRP P < HD P < HD Vmax Vmin RI P < HDF + HD HP + HD P > HDF + HD HP + HD IDH IDH Effect of various blood purification methods on intradialytic hypotension patients from the change of arterial structure and hemodynamic mechanics LI Zhuan - huan DONG Jie - cheng ZHANG Keng et al Central Hospital of Chancheng District Foshan City Guangdong Province Foshan China Abstract Objective To explore the efficacy of different blood purification methods on intradialytic hypotension IDH in maintenance hemodialysis MHD patients from the change of arterial structure and hemodynamic mechanics. Method Thirty IDH patients in hemdodialysis center of centra hospital of Chancheng District Foshan City conforming to the inclusion criteria were selected randomly divided into hemodialysis HD group n = 10 hemodiafiltration combined with hemodialysis HDF + HD group n = 10 hemoperfusion combined with hemodialysis HP + HD group n = 10 and they were observed for

2 weeks. 1The changes of blood pressure in therapy and the frequency of intradialytic hypotension were compared. 2Before and after 24 weeks of treatment serum Phosphorus P parathyroid hormone PTH C - reactive protein hs - CRP were measure. 3Their bilateral carotid intima media thickness IMT systolic peak velocity Vmax diastolic peak flow velocity Vmin resistive index RI and the incidence of atherosclerosis were detected after the treatment. Results 1Compared with HD group the frequency of intradialytic hypotension was significantly reduced in HDF + HD and HP + HD group P < serum P PTH Hs - CRP levels decreased significantly In HP + HD and HDF + HD group After the treatment for 24 weeks and reduced remarkably Compared with HD group After the treatment P < After 24 weeks treatment Vmax Vmin decreased and RI increased significantly in HD group P < Conclusion Hemodiafiltration or hemoperfusion associated with hemodilysis can improve the hemodynamic stability in IDH patients can be used as a long term therapy. Key Words Hemodiafiltration Hemoperfusion Intradialytic hypotension Vascular calcification IDH MHD ± ± 20% ~ 30% MHD 1 2 HP + HD 10 5 IDH ± ± MHD PTH < 50% Ⅲ ~ MHD Ⅳ NYHA MHD IDH P PTH hs - IDH CRP IMT P > IDH 1. 2 TR YUGA 1 TR YUGA ~ Na mmol /L K + 2 mmol /L Ca mmol /L 0. 5 mmol /L HCO ~ 34 mmol /L Gluc 0 mmol /L IDH ml /min 4 h mm Hg 1 mm Hg = kpa < 100 mm Hg < 30 mm Hg = / 1 10 ml / kg h 3 50% P > HD Mg 2 + HD HDF + HD HP + HD 10 HD ± ± 3 / 4 h / TS S 1. 3 m ~ 300 ml /min 2HDF + HD 1 HDF 2 HD 4 h / HDF TS U 0 2 HDF + HD m ~ 300 ml /min

3 HD HD 3HP + HD 1 HD + HP 2 HD IMT 3 IMT IMT HA230 2 h 1. 0 mm 2 h 200 ~ 300 ml /min HD HD HD 24 Vmin /Vmax IMT 50% RI = Vmax min 1. 4 x ± s SPSS h 1 t LSD χ 2 P < P PTH hs - P > CRP 3 24 IMT Vmax Vmin RI 1 x ± s HD HDF + HD HP + HD P / 5 /5 6 /4 5 /5 x ± s ± ± ± > x ± s ± ± ± > % PTH x ± s pmol /L ± ± ± > Hs - CRP x ± s mg /L ± ± ± > x ± s mmol /L ± ± ± > x ± s mmol /L ± ± ± > x ± s g /L ± ± ± > x ± s mm Hg ± ± ± > x ± s mm Hg ± ± ± > IMT x ± s mm ± ± ± > IDH HD % 72 10% HDF % HD %

4 % 15 P > Vmax Vmin RI 2. 1% HP + HD % % P > % HDF + HD HP + HD IDH P < HD + HDF HP + HD HD P < IDH 2. 3 P PTH hs - CRP HDF + HD HP + HD P PTH Hs - CRP P < HD HDF + HD HP + HD P < HD IMT IDH IDH IDH % HD P PTH hs - CRP x ± s P mol /ll PTH pg /ml Hs - CRP mg /L HD ± ± ± ± ± ± 3. 6 HDF + HD ± ± ± ± ± ± HP + HD ± ± ± ± ± ± P < HD 2P < x ± s IMT mm Vmax cm /s Vmin cm /s RI % HD ± ± ± ± ± ± ± ± HDF + HD ± ± ± ± ± ± ± ± HP + HD ± ± ± ± ± ± ± ± P < IDH 10 - IDH MHD Shoji 12 9 IDH IDH MHD IDH IDH IDH IDH MHD 3 IDH 4 5 MHD 1 IDH 2 IDH MHD

5 Monckeberge IDH HDF HD + HP IDH 16 IDH 17 MHD 4 1 Palmer B F Henrich W L. Recent Advances in the Pre- HDF + HD HP + HD HD vention and Management of Intradialytic Hypotension J. Journal 18 - P PTH hs - CRP MHD 21 of the American Society of Nephrology Jasn HDF + HD HP + HD 2 Shoji T Tsubakilmm Y Fujii M et al. Hemedialysis ssoci- IDH ated hypotension as an independent risk factor for two ear mortality IDH 24 HDF + HD HP + HD P in hemodialysis patients J. Kidney Int PTH Hs - CRP P < IDH HD P < IDH IDH HD IMT 4. P > Vmax Vmin RI P < HD MHD 3. J J IDH HDF + HD 5 Goodman WG Goldin J Kuizon BD et al. Coronary - ar- HP + HD IDH IMT tery calcification in young adults with end - stage renal disease HD Vmax Vmin who are undergoing dialysis J. New England Journal of Medi- RI cine P > J Kohn OF Coe FL Ing TS. Solute kinetics with short - daily 1MHD IMT home hemodialysis using slow dialysate flow rate J. Hemodial IDH Int MHD 8. α1 J MHD IDH 9 Shoji T Tsubakihara Y Fujii M et al. Hemodialysis - 2 hypotension as an independent risk factor for two - year mortality IDH in hemodialysis patients J. Kidney International Song J H Park G H Lee S Y et al. Effect of sodium > 50% balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis

6 and sodium and fluid balances J. Journal of the American Society of Nephrology Jasn Zhou YL Liu HL Duan XF et al. Impact of sodium and ultrafiltration profiling on haemodialysis - related hypotension J. Nephrology dialysis transplantation official publication of the European Dialysis and Transplant Association - European Renal Association Transplantation J J J J J. J. J. 22 McMurray JJ Adamopoulos S Anker SD et al. ESC Prakash S Reddan D Heidenheim A P et al. Central peripheral and other blood volume changes during hemodialysis J. Asaio Journal Vattikuti R Towler D A. Osteogenic regulation of vascular calcification an early perspective J. American Journal of Physiology Endocrinology & Metabolism E London G M Guérin A P Marchais S J et al. Arterial media calcification in end - stage renal disease impact on all - cause and cardiovascular mortality J. Nephrology Dialysis Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association HFA of the ESC J. Eur Heart J J D D D - D - D - D - D - D - D - D - Changes of D - dimer level in elderly patients and its clinical significance XI Yan WANG Yue - xiang The First Affiliated Hospital Of Medical College of Shihezi University Shihezi China Abstract Objective To analyze the change of D dimer level in elderly patients and its clinical significance. Method 362 D dimer positive patients were enrolled and their clinical characteristics were collected They were re-

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