透析的电生理反应：透析液钾含量及分析的作用

Santoro A, Mancini E, Gaggi R, Cavalcanti S, Severi S, Cagnoli L, Badiali F, Perrone B, London G, Fessy H, Mercadal L, Grandi F

Malpighi Nephrology Division, Policlinico S. Orsola-Malpighi, Bologna, Italy.

Contrib Nephrol. 2005;149:295-305. doi: 10.1159/000085691.

UNLABELLED

The task of dialysis therapy is, amongst other things, to remove excess potassium (K+) from the body. The need to achieve an adequate K+ removal with the risk of cardiac arrhythmias due to sudden intra-extracellular K+ gradient advises the distribution of the removal throughout the dialysis session instead of just in the first half. The aim of the study was to investigate the electrical behavior of two different K+ removal rates on myocardial cells (risk of arrhythmia and ECG alterations). Constant acetate-free biofiltration (AFB) and profiled K+ (decreasing during the treatment) AFB (AFBK) were used in a patient sample to understand, first of all, the effect on premature ventricular contraction (PVC) and on repolarization indices [QT dispersion (QTd) and principal component analysis (PCA)]. The study was divided into two phases: phase 1 was a pilot study to evaluate K+ kinetics and to test the effect on the electrophysiological response of the two procedures. The second phase was set up as an extended cross-over multicenter trial in patient subsets prone to arrhythmias during dialysis. Phase 1: PVC increased during both AFB and AFBK but less in the latter in the middle of dialysis (298 in AFB vs. 200 in AFBK). The PVC/h in a subset of arrhythmic patients was 404 +/- 145 in AFB and 309 +/- 116 in AFBK (p = 0.0028). QT interval (QTc) prolongation was less pronounced in AFBK than in AFB. Phase 2: The PVC again increased in both AFB and AFBK but less in the latter mid-way through dialysis (79 +/- 19 AFB vs. 53 +/- 13 AFBK). Moreover, in the most arrhythmic patients the benefit accruing from the smooth K+ removal rate was more pronounced (103 +/- 19 in AFB vs. 78 +/- 13 in AFBK).

CONCLUSION

It is not the K+ dialysis removal alone that can be destabilizing from an electrophysiological standpoint, but rather its removal dynamics. This is all the more evident in patients with arrhythmias who benefit from the K+ profiling during their dialysis treatment.

未标注

透析治疗的任务之一是从体内清除多余的钾离子（K+）。由于细胞内外钾离子梯度突然变化而导致心律失常的风险，需要在整个透析过程中而非仅在上半场实现足够的钾离子清除。本研究的目的是调查两种不同钾离子清除率对心肌细胞电活动的影响（心律失常风险和心电图改变）。在患者样本中采用持续无醋酸盐生物滤过（AFB）和设定钾离子清除率（治疗期间降低）的AFB（AFBK），首先了解对室性早搏（PVC）和复极指标[QT离散度（QTd）和主成分分析（PCA）]的影响。该研究分为两个阶段：第一阶段是一项初步研究，以评估钾离子动力学并测试这两种方法对电生理反应的影响。第二阶段设置为针对透析期间易发生心律失常的患者亚组的扩展交叉多中心试验。第一阶段：在AFB和AFBK期间PVC均增加，但在透析中期AFBK中的增加较少（AFB中为298，AFBK中为200）。在一部分心律失常患者中，AFB组每小时的PVC为404±145，AFBK组为309±116（p = 0.0028）。AFBK中QT间期（QTc）延长不如AFB明显。第二阶段：在AFB和AFBK中PVC再次增加，但在透析中期AFBK中的增加较少（AFB为79±19，AFBK为53±13）。此外，在心律失常最严重的患者中，平稳的钾离子清除率带来的益处更为明显（AFB中为103±19，AFBK中为78±13）。