Shifting of Blood Volume Curve Pattern Occurs According to the Change of Fluid-volume State in Maintenance Hemodialysis Patients

초록

We had recently reported the possibility that the pattern of blood volume (BV) curve is related to the fluid-volume and BP control state (Annual meeting, ASN, 2001). Briefly, we had classified BV curve into four types: type 1 of irregular curve with minor BV change; type 2 of linear decrease with reduction of BV< 10%; type 3 of sigmoid decrease showing plateau; type 4 of linear decrease with reduction of BV 10% or any shape with reduction of BV 15%. The results had suggested that the type 1 and 2 represent overhydrated state and type 3 represents euvolemic state. Type 4 was exceptional that was observed in the session with intradialytic hypotension. To know whether BV curve pattern represent fluid-volume state, we prospectively followed the effect of one-month intentional reduction of dry weight on the BV curve with the subjects who initially showed type 1 (n=30) and 2 (n=32). A further reduction of dry weight of 1.5 0.3 kg was achieved in type 1 patients (P<0.05). Predialysis BP decreased from 153.5 22.1/78.1 12.9 to 141.1 19.8(P<0.05)/75.4 11.9mmHg, and number of antihypertensives decreased from 4.1 1.9 to 3.1 1.3. At the end of study period, ultrafiltration amount per session increased from 3.2 1.0 to 4.4 0.8 L (P<0.05). A significant proportion of subjects showed a shift of BV pattern to type 2 or 4 (type 1: 18.9%; type 2: 42.2%; type 3: 38.7%; type 4: 0.2%; P<0.05). In type 2 patients, dry weight could be reduced 1.2 0.2kg (P<0.05) with the reductions of predialysis BP from 133.8 18.3/72.5 13.7mmHg to 133.1 20.8/72.5 9.6mmHg, and number of antihypertensives from 2.9 1.2 to 1.9 1.8. At the end of study period, ultrafiltration per session increased from 3.3 1.1 to 4.2 0.9L (all P<0.05). More than half shifted to type 3 (type 1: 0.9%; type 2: 30.5%; type 3: 59.3%; type 4: 9.3%; P<0.05).