低钠透析联合血液透析滤过对终末期肾脏病合并顽固性高血压患者血压节律、钙磷代谢的影响

目的:探讨低钠血液透析(hemodialysis,HD)联合血液透析滤过(Hemodiafiltration,HDF)对终末期肾脏病合并顽固性高血压的透析患者血压节律、钙磷代谢的影响。方法:将62例终末期肾脏病合并顽固性高血压患者随机分为治疗组和对照组,对照组应用常规HD治疗,每周3次,每次4 h,治疗组低钠联合HDF治疗,每周1次,3个月后进行效果评价。比较两组治疗前后血压昼夜节律、钙磷代谢变化及不良反应的发生情况。结果:治疗后,治疗组24 h收缩压(systolic blood pressure,24h SBP)、24 h舒张压(diastolic blood pressure,24h DBP)、日间收缩压(day systolic blood pressure,dSBP)、日间舒张压(day diastolic blood pressure,dSBP)、夜间收缩压(night systolic blood pressure,nSBP)、夜间舒张压(night diastolic blood pressure,nSBP)均较治疗前明显下降,且明显低于对照组(P0.05);对照组除nSBP外,其余血压指标治疗前后比较差异均无统计学意义(P0.05)。治疗后,治疗组血Ca水平较治疗前明显升高,且显著高于对照组,而血P、PTH水平较治疗前明显降低,且均明显低于对照组(P0.05)。治疗组和对照组不良反应发生率分别为16.1%、12.9%,两组比较差异无统计学意义(P0.05)。结论:低钠HD联合HDF治疗终末期肾脏病合并顽固性高血压患者可有效改善钙磷代谢并促进血压节律恢复。

Effect of Low Sodium Hemodialysis Combined with Hemodiafiltration on the Blood Pressure Rhythm and Calcium Phosphorus Metabolism in Patients with Resistant Hypertension

ABSTRACT Objective: To explore the clinical effect of low sodium hemodialysis(HD) combined with hemodiafiltration(HDF) on the blood pressure rhythm and calcium phosphorus metabolism of patients with resistant hypertension. Methods: 62 uremia patients combined with resistant hypertension were randomly divided into two groups. The control group (n=31) was treated with traditional HD alone for 2h per time, 3 times per week, and combined group (n=31) was treated with low sodium HD and HDF, once per week. The effect was evaluated at 3 months after treatment, the changes of blood pressure circadian rhythm, calcium phosphate metabolism before and after treatment as well as the incidence of adverse reactions during HD were compared between two groups. Results: The indicators of blood pressure rhythm including 24h systolic blood pressure (24hSBP), 24h diastolic blood pressure(24hDBP), day systolic blood pressure(dSBP), day diastolic blood pressure(dSBP), night systolic blood pressure(nSBP), night diastolic blood pressure(nSBP) of treatment group were significantly reduced after treatment and were significantly lower than those of the control group(P<0.05). All the indicators of blood pressure rhythm except nSBP in control group showed no significant difference between before and after treatment (P>0.05). After treatment, the levels of blood Ca in the treatment group was obviously increased, the levels of blood P, PTH were obviously decreased compared with control group(P<0.05). The incidence of adverse reactions in treatment group and control group was 16.1% and 16.1% respectively, which showed no significant difference(P>0.05). Conclusion: Low sodium HD combined with HDF can effectively remove the toxic metabolites, promote the blood pressure rhythm recovery, regulate metabolism of calcium phosphate in treating the uremia patients with resistant hypertension.