nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2004-8-2-35-39nefr-829Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSИСПОЛЬЗОВАНИЕ ДОППЛЕР-ЭХОКАРДИОГРАФИИ ДЛЯ УТОЧНЕНИЯ «СУХОГО ВЕСА» БОЛЬНОГО НА ПРОГРАММНОМ ГЕМОДИАЛИЗЕDOPPLER ECHOCARDIOGRAPHY FOR ASSESSMENT OF «DRY WEIGHT» IN CHRONIC HEMODIALYSIS PATIENTSШутовА. М.ShutovA. M.

Кафедра терапии и профессиональных болезней

МастыковВ. Э.MastykovV. E.

Кафедра терапии и профессиональных болезней

ЕдигароваО. М.EdigarovaO. M.

Кафедра терапии и профессиональных болезней

Ульяновский государственный университет и Областная клиническая больницаRussian Federation200410022004823539Copyright © Шутов А.М., Мастыков В.Э., Едигарова О.М., 20042004Шутов А.М., Мастыков В.Э., Едигарова О.М.Shutov A.M., Mastykov V.E., Edigarova O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/829

ЦЕЛЬ ИССЛЕДОВАНИЯ. Определение возможности использования допплерэхокардиографии для оценки «сухого веса» больного на программном гемодиализе. МЕТОДЫ. Обследовано 42 больных (19  мужчин, 23  женщины, средний возраст 49±11 лет), находящихся на бикарбонатном гемодиализе (4 часа х 3 раза в неделю). Допплерэхокардиография проведена до и после гемодиализа одним исследователем. Определяли следующие параметры наполнения левого желудочка: мак симальную скорость раннего диастолического наполнения (Е), максимальную скорость наполнения в систолу предсердий (А), отношение этих скоростей (Е/А), время изоволюмического расслабления (IVRT), время замедления потока раннего диастолического наполнения (DT). РЕЗУЛЬТАТЫ. Гипертрофия левого желудочка (ГЛЖ) диагностирована у 36 (87,5%) больных. Фракция выброса была ниже 45% у 3 больных. Обнаружена прямая корреляционная связь между величиной ультрафильтрации (в процентах от веса тела после гемодиализа) и динамикой скорости в пике Е (ΔE) (r=0,59;p=0,001), при этом не обнаружено связи между величиной ультрафильтрации и динамикой скорости в пике А. Показатель DT был значительно больше у больных с интрадиализной гипотензией, чем у пациентов без ИДГ (232,8±64,8 против 168,1±50,8 мс, соответственно, р < 0,001). ЗАКЛЮЧЕНИЕ. Достижение больным «сухого веса» ассоциировано у больного, имеющего гипертрофию левого желудочка, со значительным увеличением времени замедления раннего диастолического потока левого желудочка. Такие больные предрасположены к развитию интрадиализной гипотензии.

THE AIM of the work was to estimate the significance of Doppler echocardiography for the assessment of dry weight in hemodialysis patients. METHODS. Forty two dialysis patients (19M, 23 F, mean age 49±11 years) received 4 hour bicarbonate hemodialysis (HD) 3 times a week, 32 patients had arterial hypertension, 26 had chronic heart failure. Mmode echocardiography was made and left ventricular mass index (LVMI) and ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time and early deceleration time (DT) were detected. RESULTS. Left ventricular hypertrophy was diagnosed in 36 (85.7%) patients. EF was lower than 45% in 3 patients. There was a significant positive correlation between the ultrafiltration value and ΔE (r=0.59; p=0.001), no correlation being detected between the ultrafiltration value and ΔA. Patients with intradialytic hypotension had considerably higher DT than those without intradialytic hypotension (232.8±64.8 vs 168.1±50.8 ms respectively, p <0.001). CONCLUSION. «Dry weight» is associated with the significantly increased early deceleration time in patients with left ventricular hypertrophy. Patients with the increased early deceleration time have high risk of the development of intradialytic hypotension.

гемодиализдиастолическая дисфункциядопплерэхокардиографияинтрадиализная гипотензиясухой весхроническая почечная недостаточностьchronic renal failurediastolic dysfunctionDoppler echocardiographyhemodialysisdry weightintradialytic hypotensionReferencesThomson GE, Waterhouse K, McDonald HPJ, Friedman EA. Hemodialysis for chronic renal failure. Arch Intern Med 1967;120:153167Thomson GE, Waterhouse K, McDonald HPJ, Friedman EA. Hemodialysis for chronic renal failure. Arch Intern Med 1967;120:153167Charra B, Laurent G, Calemard E et al. Clinical assessment of dry weight. Nephrol Dial Transplant 1996;11:16 19Charra B, Laurent G, Calemard E et al. Clinical assessment of dry weight. Nephrol Dial Transplant 1996;11:16 19Cai Y, Zimmerman A, Ladefoged S, Secher NH. Can haemodialysisinduced hypotension be predicted? Nephron 2002; 92: 582588Cai Y, Zimmerman A, Ladefoged S, Secher NH. Can haemodialysisinduced hypotension be predicted? Nephron 2002; 92: 582588Cheriex EC, Leunissen KM, Jannsen JH et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of «dry weight» in haemodialysis patients. Nephrol Dial Transplant 1989; 4: 563568Cheriex EC, Leunissen KM, Jannsen JH et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of «dry weight» in haemodialysis patients. Nephrol Dial Transplant 1989; 4: 563568Schneditz D, Levin NW. Noninvasive blood volume monitoring during hemodialysis: technical and physiological aspects. Semin Dial 1997;10:166170Schneditz D, Levin NW. Noninvasive blood volume monitoring during hemodialysis: technical and physiological aspects. Semin Dial 1997;10:166170Leypoldt JK, Cheung AK, Steuer RR et al. Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol 1995; 6: 214219Leypoldt JK, Cheung AK, Steuer RR et al. Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol 1995; 6: 214219Wu C, Lin Y, Yu W et al. The assessment of fluid status in haemodialysis patients: usefulness of the Doppler echocardiographic parameters. Nephrol Dial Transplant 2004; 19: 644651Wu C, Lin Y, Yu W et al. The assessment of fluid status in haemodialysis patients: usefulness of the Doppler echocardiographic parameters. Nephrol Dial Transplant 2004; 19: 644651Шутов АМ, Мастыков ВЭ, Едигарова ОМ. Диастоли ческая дисфункция и интрадиализная гипотензия. Нефро логия и диализ 2003; 2: 156160Шутов АМ, Мастыков ВЭ, Едигарова ОМ. Диастоли ческая дисфункция и интрадиализная гипотензия. Нефро логия и диализ 2003; 2: 156160Sahn DJ, DeMaria A, Kissio J, Weyman A. Recommendations regarding quantitation in Mmode echocardiography: results of a survey of echocardiographic measurements. Circulation1978; 58: 10721083Sahn DJ, DeMaria A, Kissio J, Weyman A. Recommendations regarding quantitation in Mmode echocardiography: results of a survey of echocardiographic measurements. Circulation1978; 58: 10721083Schiller NB, Shan PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358367Schiller NB, Shan PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358367Рекомендации по диагностике и лечению хронической сердечной недостаточности. Доклад экспертной группы по диагностике и лечению хронической сердечной недостаточности Европейского общества кардиологов. Сердечная недостаточность 2001; 6: 251276Рекомендации по диагностике и лечению хронической сердечной недостаточности. Доклад экспертной группы по диагностике и лечению хронической сердечной недостаточности Европейского общества кардиологов. Сердечная недостаточность 2001; 6: 251276Devereux RB, Alomso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol 1986; 57: 450 458Devereux RB, Alomso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol 1986; 57: 450 458Abergel E, Tase M, Bohlader J. Which definition for echocardiographic left ventricular hypertrophy? Am J Cardiol 1995; 75: 486503Abergel E, Tase M, Bohlader J. Which definition for echocardiographic left ventricular hypertrophy? Am J Cardiol 1995; 75: 486503Ganau A, Devereux RB, Roman MJ et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 15501558Ganau A, Devereux RB, Roman MJ et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 15501558Kim KE, Neff M, Cohen B et al. Blood volume changes and hypotension during hemodialysis. Trans Am Soc Artif Intern Organs 1970; 16: 508514Kim KE, Neff M, Cohen B et al. Blood volume changes and hypotension during hemodialysis. Trans Am Soc Artif Intern Organs 1970; 16: 508514Passauer J, Bussemaker E, Gross P. Dialysis hypotension: Do we see light at the end of the tunnel? Nephrol Dial Transplant 1998; 13: 30243029Passauer J, Bussemaker E, Gross P. Dialysis hypotension: Do we see light at the end of the tunnel? Nephrol Dial Transplant 1998; 13: 30243029Rouby JJ, Rottembourg J, Durande JP et al. Importance of the plasma refilling rate in genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration haemodialysis. Proc Eur Dial Transplant Assoc 1978; 14: 239244Rouby JJ, Rottembourg J, Durande JP et al. Importance of the plasma refilling rate in genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration haemodialysis. Proc Eur Dial Transplant Assoc 1978; 14: 239244Schroeder KL, Sallustio JE, Ross EA. Continuous haematocrit monitoring during intradialytic hypotension: precipitous decline in plasma refill rates. Nephrol Dial Transplant 2004; 19: 652656Schroeder KL, Sallustio JE, Ross EA. Continuous haematocrit monitoring during intradialytic hypotension: precipitous decline in plasma refill rates. Nephrol Dial Transplant 2004; 19: 652656Charra B. «Dry weight» in dialysis: the history of a concept. Nephrol Dial Transplant 1998; 13: 18821885Charra B. «Dry weight» in dialysis: the history of a concept. Nephrol Dial Transplant 1998; 13: 18821885Traeger J, Gulland R, Arkouche W et al. Short daily hemodialysis: A fouryear experience. Dialysis &Transplantation 2001; 30: 7686Traeger J, Gulland R, Arkouche W et al. Short daily hemodialysis: A fouryear experience. Dialysis &Transplantation 2001; 30: 7686Charra B, Jean G, Chazot C et al. Intensive dialysis and blood control: A review. Hemodial Int 2004; 8: 5160Charra B, Jean G, Chazot C et al. Intensive dialysis and blood control: A review. Hemodial Int 2004; 8: 5160Charra B, Bergstrоm J, Scribner B. Blood pressure control in dialysis patients: Importance of the lag phenomen. Am J Kidney Dis 1998; 32: 720724Charra B, Bergstrоm J, Scribner B. Blood pressure control in dialysis patients: Importance of the lag phenomen. Am J Kidney Dis 1998; 32: 720724Katzarski KS, Filho JCD, Bergstrоm J. Extracellular volume changes and blood pressure levels in hemodialysis patients. Hemodial Int 2003; 7: 135142Katzarski KS, Filho JCD, Bergstrоm J. Extracellular volume changes and blood pressure levels in hemodialysis patients. Hemodial Int 2003; 7: 135142Robinson TG, Carr SJ. Cardiovascular autonomic dysfunction in uremia. Kidney Int 2002; 62: 19211932Robinson TG, Carr SJ. Cardiovascular autonomic dysfunction in uremia. Kidney Int 2002; 62: 19211932Barnas MGW, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during hemodialysis hypotension. J Am Soc Nephrol 1999; 10: 2577 2584Barnas MGW, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during hemodialysis hypotension. J Am Soc Nephrol 1999; 10: 2577 2584Cheriex EC, Leunissen KML, Janssen JHA et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of «dry weight» in hemodialysis patients. Nephrol Dial Transplant 1989; 4: 563568Cheriex EC, Leunissen KML, Janssen JHA et al. Echography of the inferior vena cava is a simple and reliable tool for estimation of «dry weight» in hemodialysis patients. Nephrol Dial Transplant 1989; 4: 563568Schumacher J, Rob P, Kreft B et al. Measurement of fluid volume shifts during hemodialysis by Mmode ultrasonography. Blood Purif 2000; 18: 103109Schumacher J, Rob P, Kreft B et al. Measurement of fluid volume shifts during hemodialysis by Mmode ultrasonography. Blood Purif 2000; 18: 103109Zhu F, Schneditz D, Wang E et al. Validation of changes in extracellular volume measured during hemodialusis using a segmental bioimpedance technique. ASAIO J 1998; 44: M541 M545Zhu F, Schneditz D, Wang E et al. Validation of changes in extracellular volume measured during hemodialusis using a segmental bioimpedance technique. ASAIO J 1998; 44: M541 M545Kouw PM, Kooman JP, Cheriex EC et al. Assessment of postdialysis dry weight: a comparison of techniques. J Am Soc Nephrol 1993; 4: 98104Kouw PM, Kooman JP, Cheriex EC et al. Assessment of postdialysis dry weight: a comparison of techniques. J Am Soc Nephrol 1993; 4: 98104Zoccali C, Mallamaci F, Benedetto FA et al. Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. J Am Soc Nephrol 2001; 12: 15081515Zoccali C, Mallamaci F, Benedetto FA et al. Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. J Am Soc Nephrol 2001; 12: 15081515Katzarski KS, Nisell J, Randmaa I et al. A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients. Am J Kidney Dis 1997; 30: 459465Katzarski KS, Nisell J, Randmaa I et al. A critical evaluation of ultrasound measurement of inferior vena cava diameter in assessing dry weight in normotensive and hypertensive hemodialysis patients. Am J Kidney Dis 1997; 30: 459465Шутов АМ, Куликова ЕС, Кондратьева НИ. Диагностика диастолической дисфункции левого желудочка у больных с додиализной хронической почечной недостаточностью. Тер архив 2003; 6: 4650Шутов АМ, Куликова ЕС, Кондратьева НИ. Диагностика диастолической дисфункции левого желудочка у больных с додиализной хронической почечной недостаточностью. Тер архив 2003; 6: 4650Mitsnefes MM, Kimbell TR, Border WL et al. Impaired left ventricular diastolic function in children with chronic renal failure. Kidney Int 2004; 65: 14611466Mitsnefes MM, Kimbell TR, Border WL et al. Impaired left ventricular diastolic function in children with chronic renal failure. Kidney Int 2004; 65: 14611466Simek CL, Feldman MD, Haber HL et al. Relationship between left ventricular wall thickness and left atrial size: Comparison with other measures of diastolic function. J Am Soc Echocardiogr 1995; 8: 3747Simek CL, Feldman MD, Haber HL et al. Relationship between left ventricular wall thickness and left atrial size: Comparison with other measures of diastolic function. J Am Soc Echocardiogr 1995; 8: 3747How to diagnose diastolic heart failure. European Study Group on Diastolic Heart Failure. Eur Heart J 1998; 19: 990 1003How to diagnose diastolic heart failure. European Study Group on Diastolic Heart Failure. Eur Heart J 1998; 19: 990 1003

The authors declare that there are no conflicts of interest present.