CONDITION OF LIQUID SPACES OF THE ORGANISM AT PATIENTS WITH CHRONIC KIDNEY DISEASE RECEIVING TREATMENT BY THE PROGRAM HEMODIALYSIS

THE AIM OF RESEARCH: to compare an ultrafiltration volume adequacy estimation by clinical method and bioimpedance method and to define its influence on arterial pressure dynamics during hemodialysis (HD) session and myocardium remodelling indicators. PATIENTS AND METHODS. Examined 122 patients with CKD V receiving treatment by program HD (74 men and 48 women). Patients were divided on 3 groups: 1 group – 27 patients with the hypohydration, 2 group – 46 patients with normohydration, 3 group – 49 patients with hyperhydration. For central haemodynamics characteristics estimation echocardiographic research on the device Vivid 7Pro was carried out. As referential clinical method of ultrafiltration volume (UV) determination was used twofrequency bioimpedance with rheograph Diamant-R. Arterial pressure monitoring was carried out by bedside Draeger Infinity Vista XL monitor: 30 minutes before HD session, further each 30 minutes, and also 30 minutes after HD. RESULTS. In hypohydrated group clinically calculated UV was overestimated, therefore extracellular water volume deficiency after HD increased to 1,682±0,079 l. In normohydrated group clinically calculated UV was adequate. In group of the hyperhydrated patients clinically calculated UV was underestimated, therefore after HD excess of liquid increased to 1,176±0,186 l. Systolic arterial pressure dynamics on HD in all groups was similar. At echocardiography most expressed hypertrophy of the left ventricle was revealed both in group of hyperhydrated and in group of hypohydrated patients. CONCLUSION. Adequate laboratory evaluation of ultrafiltration necessary volume can slow down development of left ventricle hypertrophy in HD patients.

1. Суворов АВ, Зубеева ГН, Суслова ОА и др. Особенности артериальной гипертензии у пациентов с терминальной хронической почечной недостаточностью в додиализном и диализном периодах. Мед альманах 2010; 4: 249-251

2. Шишкин АН, Федорова ЮЮ. Интрадиализная гипотония: факторы, ассоциированные с процедурой гемодиализа. Нефрология 2012; 16 (2):64-38

3. Kooman J, Basci A, Pizzarelli F et al. EBPG guidline on haemodynamic instability. Nephrol Dial Transplant 2007; 22(2): 22-44

4. Palmer BF. Can chronic volume overload be recognized and prevented in hemodialysis patients? Semin Dial 2009; 22(5): 489-491

5. Phillipps LM, Harris DC. Review: modeling the dialysate. Nephrology (Carlton) 2010; 15(4): 393-398

6. Бовкун ИВ, Румянцев АШ Оценка тактики проведения сеанса гемодиализа у больных с разной величиной артериального давления. Нефрология 2006; 10 (3): 62-67

7. Bonello M, House AA, Cruz D et al. Integration of blood volume, blood pressure, heart rate and bioimpedance monitoring for the achievement of optimal dry body weight during chronic hemodialysis. Int J Artif Organs 2007; 30 (12):1098-1108

8. Jaffrin MY, Morel H Body fluid volumes measurements by impedance: A review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods. Med Eng Phys 2008 Dec; 30(10):1257-1269

9. Douglas PS, Garcia MJ, Haines DE et al. ACCF/ASE/AHA/ ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011;57(9):1126-1166

10. Daugirdas JT. Simplified equations for monitoring Kt/V, PCRn, eKT/V and ePCRn. Adv Ren Replace Ther 1995; 2 (4): 295-304

11. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences be-tween facilities. Am J Kidney Dis 1990; 15(5): 458-482

12. Charra B, Calemard E, Cuche M, Laurent G. Control of hypertension and prolonged survival on maintenance hemodialysis. Nephron 1983;33(2):96-99

13. Raimann J, Liu L, Tyagi S. et al. A fresh look at dry weight. Hemodial Int 2008;12(4):395-405

14. Смирнов А.В. Заместительная почечная терапия. Нефрология 2011; 15 (1): 33-46

15. Brooks ER, Fatallah-Shaykh SA, Langman CB. et al. Bioelectric impedance predicts total body water, blood pressure, and heart rate during hemodialysis in children and adolescents. J Ren Nutr 2008;18(3):304-311

16. Onofriescu M, Mardare NG, Segall L. et al. Randomized trial of bioelectrical impedance analysis versus clinical criteria for guiding ultrafiltration in hemodialysis patients: effects on blood pressure, hydration status, and arterial stiffness. Int Urol Nephrol 2012;44(2):583-591

17. Kolmakova EV, Haller ST, Kennedy DJ. et al.Endogenous cardiotonic steroids in chronic renal failure. Nephrol Dial Transplant 2011;26(9):2912-2919