Kronik hemodiyaliz hastalarında diyalizat akım hızı azaltılmasının etkilerinin online Kt/V ile değerlendirilmesi
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Tarih
2022
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tüm dünyada iklim değişikliği nedeniyle tatlı su kaynakları azalmaktadır. Diyalizat akım hızının azaltılmasının diyaliz yeterliliğine etkisi ve hemodiyaliz esnasında kullanılan saf su miktarının azaltılıp azaltılamayacağının değerlendirilmesidir. Yöntem: Haftada 3 seans rutin hemodiyaliz tedavisi alan 18 yaş üstü 81 hastada (kadın ve erkek) prospektif çalışma yapıldı. Her hasta 3'er seans diyalizat akım hızı(Qd) 300 ml/dk ve 500 ml/dk ile diyalize alındı. Diyaliz süresi (4 saat) ve kan akım hızı (300 ml/dk) bütün katılımcılarda sabit tutuldu. Hastalar tüm diyaliz seanslarına aynı marka, özellik ve yüzey alanına sahip diyalizör membranı ile alındı. Her seansın 2. ve 4. Saatinde hemodiyaliz cihazı ile online Kt/V ölçümü yapıldı. Her seansta ultrafiltrasyon miktarı, venöz basınç, arteryal basınç, giriş kan basıncı ve çıkış kan basıncı kaydedildi. Bulgular: Çalışmamıza dahil edilen 81 hastanın %50,6'sı (n=41) kadın, %49,4'ü (n=40) erkekti. Hastaların yaş ortalaması 49,65±16,64 yıl, kilo ortalaması 63,14±15,50 kg ve VKI ortalaması 23,86±5,17 idi. Hastalar ortalama 70,86±63,69 aydır hemodiyalize girmekteydi Tüm grupta dördüncü saat online Kt/V değerleri incelendiğinde Qd=300 ml/dk ile Qd=500 ml/dk arasında anlamlı farklılık saptanmamıştır (p>0,05). Diyaliz seansı sonundaki ortalama arter basıncı (OAB) ve diyaliz seansı öncesindeki OAB arasındaki fark incelendiğinde diyalizat akım hızının 300 ml/dk veya 500 ml/dk olması arasında anlamlı farklılık saptanmamıştır (p>0,05). Qd=500 ml/dk ile yapılan diyalizlerde ultrafiltrasyon (UF) miktarı daha yüksek bulunmuştur (p<0,05). Kadın hastalarda dördüncü saat online Kt/V değerleri incelendiğinde Qd=300 ml/dk ile Qd=500 ml/dk arasında anlamlı farklılık saptanmamıştır (p>0,05). Erkek hastalarda Qd=500 ml/dk ile online Kt/V daha yüksek idi (p<0,05). 65 kg ve altındaki hastalarda diyalizat akım hızının 300 ml/dk veya 500 ml/dk olması online Kt/V'de anlamlı olarak farklılığa yol açmamıştır (p>0,05). 65 kg üzerindeki hastalarda online Kt/V değerleri Qd=500 ml/dk ile daha yüksek tespit edildi (p<0,05). 1,5 m2 ve 1,7 m2 diyalizör membranı kullanan hastalarda, online Kt/V diyalizat akım hızının 300 ml/dk veya 500 ml/dk olması ile değişmemiştir (p>0,05). 1,8 m2 ve 2,1 m2 diyalizör membranı kullanan hastalarda online Kt/V, Qd=500 ml/dk ile daha yüksek bulunmuştur (p<0,05). Kadınlarda, 65 ve altında vücut ağırlığına sahip hastalarda ve 1,8 m2'den küçük yüzey alanına sahip membran kullanılan hastalarda online Kt/V diyalizat akım hızının azalmasıyla değişmemiştir. Oysaki; erkeklerde, 65 kg üzerinde vücut ağırlığına sahip hastalarda ve ≥1,8 m2 yüzey alanlı membran kullanılan hastalarda online Kt/V, Qd=500 ml/dk ile daha yüksek bulundu. Yani bu hasta gruplarında diyalizat akım hızı düşürülmemelidir. Sonuç: Kronik hemodiyaliz hastalarında diyalizat akım hızının 500 ml/dk'dan 300 ml/dk'ya düşürülmesi online Kt/V değerlerini değiştirmemiştir. Dolayısıyla diyalizat akım hızını azaltarak su tasarrufu sağlanabilir.
Fresh water resources are decreasing all over the world due to climate change. The effect of reducing the dialysate flow rate on dialysis adequacy and evaluating whether the amount of distilled water used during hemodialysis can be reduced. Methods: A prospective study was conducted in 81 patients (male and female) over the age of 18 who received 3 sessions of routine hemodialysis per week. Each patient was dialyzed with 3 sessions of dialysate flow rate (Qd) of 300 ml/min and 500 ml/min. Dialysis time (4 hours) and blood flow rate (300 ml/min) were kept constant in all participants. The patients were taken to all dialysis sessions with the same brand, feature and surface area of the dialyzer membrane. Online Kt/V measurement was made with the hemodialysis device at the 2nd and 4th hours of each session. Ultrafiltration amount, venous pressure, arterial pressure, inlet blood pressure and outlet blood pressure were recorded in each session. Results: Of the 81 patients included in our study, 50.6% (n=41) were female and 49.4% (n=40) were male. The mean age of the patients was 49.65±16.64 years, the mean weight was 63.14±15.50 kg, and the mean BMI was 23.86±5.17. The patients had been on hemodialysis for an average of 70.86±63.69 months. When the fourth hour online Kt/V values were examined in the entire group, no significant difference was found between Qd=300 ml/min and Qd=500 ml/min (p>0.05). When the difference between mean arterial pressure (MAP) at the end of the dialysis session and MAP before the dialysis session was examined, no significant difference was found between the dialysate flow rate of 300 ml/min or 500 ml/min (p>0.05). Ultrafiltration (UF) amount was found to be higher in dialysis performed with Qd=500 ml/min (p<0.05). When the fourth hour online Kt/V values were analyzed in female patients, no significant difference was found between Qd=300 ml/min and Qd=500 ml/min (p>0.05). Online Kt/V was higher in male patients with Qd=500 ml/min (p<0.05). Dialysate flow rate of 300 ml/min or 500 ml/min in patients with 65 kg or less did not cause a significant difference in online Kt/V (p>0.05). Online Kt/V values were found to be higher with Qd=500 ml/min in patients over 65 kg (p<0.05). In patients using 1.5 m2 and 1.7 m2 dialyzer membranes, the online Kt/V dialysate flow rate did not change with 300 ml/min or 500 ml/min (p>0.05). Online Kt/V was found to be higher with Qd=500 ml/min in patients using 1.8 m2 and 2.1 m2 dialyzer membranes (p<0.05). Online Kt/V dialysate did not change with decreasing flow rate in women, in patients with a body weight of 65 and below, and in patients using membranes with a surface area of less than 1.8 m2. But; Online Kt/V was found to be higher with Qd=500 ml/min in men, in patients with a body weight over 65 kg and in patients using membranes with a surface area of ≥1.8 m2. In other words, the dialysate flow rate should not be reduced in these patient groups. Conclusion: Decreasing the dialysate flow rate from 500 ml/min to 300 ml/min in chronic hemodialysis patients did not change online Kt/V values. Therefore, water savings can be achieved by reducing the dialysate flow rate.
Fresh water resources are decreasing all over the world due to climate change. The effect of reducing the dialysate flow rate on dialysis adequacy and evaluating whether the amount of distilled water used during hemodialysis can be reduced. Methods: A prospective study was conducted in 81 patients (male and female) over the age of 18 who received 3 sessions of routine hemodialysis per week. Each patient was dialyzed with 3 sessions of dialysate flow rate (Qd) of 300 ml/min and 500 ml/min. Dialysis time (4 hours) and blood flow rate (300 ml/min) were kept constant in all participants. The patients were taken to all dialysis sessions with the same brand, feature and surface area of the dialyzer membrane. Online Kt/V measurement was made with the hemodialysis device at the 2nd and 4th hours of each session. Ultrafiltration amount, venous pressure, arterial pressure, inlet blood pressure and outlet blood pressure were recorded in each session. Results: Of the 81 patients included in our study, 50.6% (n=41) were female and 49.4% (n=40) were male. The mean age of the patients was 49.65±16.64 years, the mean weight was 63.14±15.50 kg, and the mean BMI was 23.86±5.17. The patients had been on hemodialysis for an average of 70.86±63.69 months. When the fourth hour online Kt/V values were examined in the entire group, no significant difference was found between Qd=300 ml/min and Qd=500 ml/min (p>0.05). When the difference between mean arterial pressure (MAP) at the end of the dialysis session and MAP before the dialysis session was examined, no significant difference was found between the dialysate flow rate of 300 ml/min or 500 ml/min (p>0.05). Ultrafiltration (UF) amount was found to be higher in dialysis performed with Qd=500 ml/min (p<0.05). When the fourth hour online Kt/V values were analyzed in female patients, no significant difference was found between Qd=300 ml/min and Qd=500 ml/min (p>0.05). Online Kt/V was higher in male patients with Qd=500 ml/min (p<0.05). Dialysate flow rate of 300 ml/min or 500 ml/min in patients with 65 kg or less did not cause a significant difference in online Kt/V (p>0.05). Online Kt/V values were found to be higher with Qd=500 ml/min in patients over 65 kg (p<0.05). In patients using 1.5 m2 and 1.7 m2 dialyzer membranes, the online Kt/V dialysate flow rate did not change with 300 ml/min or 500 ml/min (p>0.05). Online Kt/V was found to be higher with Qd=500 ml/min in patients using 1.8 m2 and 2.1 m2 dialyzer membranes (p<0.05). Online Kt/V dialysate did not change with decreasing flow rate in women, in patients with a body weight of 65 and below, and in patients using membranes with a surface area of less than 1.8 m2. But; Online Kt/V was found to be higher with Qd=500 ml/min in men, in patients with a body weight over 65 kg and in patients using membranes with a surface area of ≥1.8 m2. In other words, the dialysate flow rate should not be reduced in these patient groups. Conclusion: Decreasing the dialysate flow rate from 500 ml/min to 300 ml/min in chronic hemodialysis patients did not change online Kt/V values. Therefore, water savings can be achieved by reducing the dialysate flow rate.
Açıklama
Anahtar Kelimeler
Hemodiyaliz, Diyalizat akım hızı, Diyaliz yeterliliği, Su tasarrufu, Hemodialysis, Dialysate flow rate, Dialysis adequacy, Water saving
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Aktaş. A. (2022). Kronik hemodiyaliz hastalarında diyalizat akım hızı azaltılmasının etkilerinin online Kt/V ile değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
