Korean Journal of Nephrology 1998;17(1):104-109.

고나트륨 투석액 혈액투석이 혈압에 미치는 영향

송호철 , 최의진 , 이대훈 , 박순민 , 김연식 , 정성원 , 윤성로 , 윤선애 , 안석주 ,방병기

Abstract

Hypotensive episode is one of the serious compli- cation during hemodialysis. HSD has used for relief of this problem, but sometimes increased interdia- lytic weight gain or exacerbation of hypotension are happened. To evaluate the effect of HSD, 7 non- diabetic normotensive uremic patients were hemo- dialyzed with different sodium level of dialysate (stage A: Na 138mEq/L for. 4hrs, stage B: Na 148mEq/L for 4hrs, stage C: initially Na 148mEq/L for 3hrs and Na 138mEq/L for 1hrs), and each stages were continued for 2 weeks. Ultrafiltration was performed to maintain the patient's estimated dry weight constantly. Interdialytic weight gain(stage A ' 2.9±1.2kg, stage B:3.2±4.1kg, stage C:3.1±0.8kg) and presystolic systolic and diastolic blood pressure were not different in each stage. The incidence of hypotension (systolic BP<90mmg) during hemodialysis was significantly lower in stage B and stage C(24%, 21%) than stage A(54%)(P<0.01). During hemo- dialysis the incidence of thirst was higher in stage B(40%) than stage A and stage C(11%, 12%) (P<0.05) significantly but there are no difference in headache and itching during hemodialysis between the each stage. Pre-dialysis and post-dialysis serum sodium and osmolality were not different in each stage but at 2 hrs after initiation of hemodialysis serum sodium and osmolality were higher in stage B(145.6±2.1mEq/L, 306±6.7mOsm/kg) and stage C (146.1±2.1mEq/L, 306±13.1mOsm/kg) than stage A (140.1±2.5mEq/L, 292±8.7mOsm/kg)(P<0.05). The ANP levels of predialysis and post-dialysis were not different in each stage. In conclusion, HSD improved hypotenive episode. In spite of sodium load, increased interdialytic wei ght gain and elevation of predialysis blood pressure were not developed and sodium modeling during hemodialysis attenuate some adverse effect of HSD.