血液透析脫水速度有沒有上限?

當然有,來看看研究能告訴我們哪些事情。

首先是2006年的研究,七個國家的跨國大型研究,共有22000人參與,結論:透析時間越長,以及脫水速度越慢死亡率越低

透析時間長,我們會想到清除率(Kt/V)當然更好,當然死亡率越低,但這篇研究特別告訴我們是:透析時間長清除率高,兩者皆為降低死亡率的獨立因子。這個研究中,歐洲國家比美國的透析時間平均長21分鐘,甚至,日本比美國的透析時間平均長33分鐘!日本的死亡率可以比美國低快要20%!(RR=0.81; P=0.0005)

單單把透析時間拉長,就能夠降低死亡率,那麼脫水速度呢?這篇是用脫水速度 10 cc/kg/hr 當分界,把患者分成兩組,發現大於這個速度者,死亡率會增加,透析中間發生低血壓的情況,也會增加。意思就是:洗的比較容易不舒服啦!

第二篇是2011年的研究,1846人的研究,直接先看圖:

脫水速度

可以很清楚的看出,只要脫水速度大於 10 cc/kg/hr,死亡率就開始上升,文中把大於 13 cc/kg/hr 的患者再分一組,這樣的脫水速度,不管是總死亡率、還是心血管疾病的死亡率,都顯著增加。

用這樣的數據,就可以算出患者一次最多能脫水的量,透析時間都用四個小時計算,以下表格幫助速算:

患者體重 (公斤) 40  50  60  70 
10 cc/kg/hr 是多少水? 1.6公斤 2.0公斤 2.4公斤 2.8公斤
13 cc/kg/hr 是多少水? 2.0公斤 2.6公斤  3.1公斤  3.6公斤

如果用體重的百分比來算,四小時的透析時間,所能透析的體重最好在 4% 以下 (10 cc/kg/hr),最多不可超過 5.2% (13 cc/kg/hr) 。

想要脫更多水?可以,請延長時間!延長透析時間既可以增加清除率,降低死亡率,又能使脫水速度變慢,一舉三得!

結論:洗腎患者要控制水分攝取,兩次透析之間的體重增加,不能超過上述的數據,不然洗的不舒服、又比別人容易心血管疾病掛掉。

{2147300:5NQFHGDR};{2147300:6EPDXFT3};{2147300:5NQFHGDR} pediatrics default asc 1 657
%7B%22status%22%3A%22success%22%2C%22updateneeded%22%3Afalse%2C%22instance%22%3Afalse%2C%22meta%22%3A%7B%22request_last%22%3A0%2C%22request_next%22%3A0%2C%22used_cache%22%3Atrue%7D%2C%22data%22%3A%5B%7B%22key%22%3A%225NQFHGDR%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Saran%20et%20al.%22%2C%22parsedDate%22%3A%222006-02-15%22%2C%22numChildren%22%3A2%7D%2C%22bib%22%3A%22%26lt%3Bdiv%20class%3D%26quot%3Bcsl-bib-body%26quot%3B%20style%3D%26quot%3Bline-height%3A%201.35%3B%20%26quot%3B%26gt%3B%5Cn%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-entry%26quot%3B%20style%3D%26quot%3Bclear%3A%20left%3B%20%26quot%3B%26gt%3B%5Cn%20%20%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-left-margin%26quot%3B%20style%3D%26quot%3Bfloat%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%26quot%3B%26gt%3B1.%20%26lt%3B%5C%2Fdiv%26gt%3B%26lt%3Bdiv%20class%3D%26quot%3Bcsl-right-inline%26quot%3B%20style%3D%26quot%3Bmargin%3A%200%20.4em%200%201.5em%3B%26quot%3B%26gt%3BSaran%20R%2C%20Bragg-Gresham%20JL%2C%20Levin%20NW%2C%20et%20al.%20Longer%20treatment%20time%20and%20slower%20ultrafiltration%20in%20hemodialysis%3A%20Associations%20with%20reduced%20mortality%20in%20the%20DOPPS.%20%26lt%3Bi%26gt%3BKidney%20Int%26lt%3B%5C%2Fi%26gt%3B.%202006%3B69%287%29%3A1222-1228.%20%26lt%3Ba%20class%3D%26%23039%3Bzp-DOIURL%26%23039%3B%20target%3D%26%23039%3B_blank%26%23039%3B%20rel%3D%26%23039%3Bnoopener%20noreferrer%26%23039%3B%20href%3D%26%23039%3Bhttp%3A%5C%2F%5C%2Fdoi.org%5C%2F10.1038%5C%2Fsj.ki.5000186%26%23039%3B%26gt%3Bhttp%3A%5C%2F%5C%2Fdoi.org%5C%2F10.1038%5C%2Fsj.ki.5000186%26lt%3B%5C%2Fa%26gt%3B%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%20%20%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%26lt%3B%5C%2Fdiv%26gt%3B%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22Longer%20treatment%20time%20and%20slower%20ultrafiltration%20in%20hemodialysis%3A%20Associations%20with%20reduced%20mortality%20in%20the%20DOPPS%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22R.%22%2C%22lastName%22%3A%22Saran%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22J.%20L.%22%2C%22lastName%22%3A%22Bragg-Gresham%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22N.%20W.%22%2C%22lastName%22%3A%22Levin%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Z.%20J.%22%2C%22lastName%22%3A%22Twardowski%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22V.%22%2C%22lastName%22%3A%22Wizemann%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22A.%22%2C%22lastName%22%3A%22Saito%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22N.%22%2C%22lastName%22%3A%22Kimata%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22B.%20W.%22%2C%22lastName%22%3A%22Gillespie%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22C.%22%2C%22lastName%22%3A%22Combe%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22J.%22%2C%22lastName%22%3A%22Bommer%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22T.%22%2C%22lastName%22%3A%22Akiba%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22D.%20L.%22%2C%22lastName%22%3A%22Mapes%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22E.%20W.%22%2C%22lastName%22%3A%22Young%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22F.%20K.%22%2C%22lastName%22%3A%22Port%22%7D%5D%2C%22abstractNote%22%3A%22Longer%20treatment%20time%20%28TT%29%20and%20slower%20ultrafiltration%20rate%20%28UFR%29%20are%20considered%20advantageous%20for%20hemodialysis%20%28HD%29%20patients.%20The%20study%20included%2022%20000%20HD%20patients%20from%20seven%20countries%20in%20the%20Dialysis%20Outcomes%20and%20Practice%20Patterns%20Study%20%28DOPPS%29.%20Logistic%20regression%20was%20used%20to%20study%20predictors%20of%20TT%26gt%3B240%20min%20and%20UFR%26gt%3B10%20ml%5C%2Fh%5C%2Fkg%20bodyweight.%20Cox%20regression%20was%20used%20for%20survival%20analyses.%20Statistical%20adjustments%20were%20made%20for%20patient%20demographics%2C%20comorbidities%2C%20dose%20of%20dialysis%20%28Kt%5C%2FV%29%2C%20and%20body%20size.%20Europe%20and%20Japan%20had%20significantly%20longer%20%28P%26lt%3B0.0001%29%20average%20TT%20than%20the%20US%20%28232%20and%20244%20min%20vs%20211%20in%20DOPPS%20I%3B%20235%20and%20240%20min%20vs%20221%20in%20DOPPS%20II%29.%20Kt%5C%2FV%20increased%20concomitantly%20with%20TT%20in%20all%20three%20regions%20with%20the%20largest%20absolute%20difference%20observed%20in%20Japan.%20TT%26gt%3B240%20min%20was%20independently%20associated%20with%20significantly%20lower%20relative%20risk%20%28RR%29%20of%20mortality%20%28RR%3D0.81%3B%20P%3D0.0005%29.%20Every%2030%20min%20longer%20on%20HD%20was%20associated%20with%20a%207%25%20lower%20RR%20of%20mortality%20%28RR%3D0.93%3B%20P%26lt%3B0.0001%29.%20The%20RR%20reduction%20with%20longer%20TT%20was%20greatest%20in%20Japan.%20A%20synergistic%20interaction%20occurred%20between%20Kt%5C%2FV%20and%20TT%20%28P%3D0.007%29%20toward%20mortality%20reduction.%20UFR%26gt%3B10%20ml%5C%2Fh%5C%2Fkg%20was%20associated%20with%20higher%20odds%20of%20intradialytic%20hypotension%20%28odds%20ratio%3D1.30%3B%20P%3D0.045%29%20and%20a%20higher%20risk%20of%20mortality%20%28RR%3D1.09%3B%20P%3D0.02%29.%20Longer%20TT%20and%20higher%20Kt%5C%2FV%20were%20independently%20as%20well%20as%20synergistically%20associated%20with%20lower%20mortality.%20Rapid%20UFR%20during%20HD%20was%20also%20associated%20with%20higher%20mortality%20risk.%20These%20results%20warrant%20a%20randomized%20clinical%20trial%20of%20longer%20dialysis%20sessions%20in%20thrice-weekly%20HD.%22%2C%22date%22%3A%22February%2015%2C%202006%22%2C%22language%22%3A%22en%22%2C%22DOI%22%3A%2210.1038%5C%2Fsj.ki.5000186%22%2C%22ISSN%22%3A%220085-2538%22%2C%22url%22%3A%22http%3A%5C%2F%5C%2Fwww.nature.com%5C%2Fki%5C%2Fjournal%5C%2Fv69%5C%2Fn7%5C%2Fabs%5C%2F5000186a.html%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-03-28T08%3A58%3A41Z%22%7D%7D%2C%7B%22key%22%3A%226EPDXFT3%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Flythe%20et%20al.%22%2C%22parsedDate%22%3A%222011-01%22%2C%22numChildren%22%3A2%7D%2C%22bib%22%3A%22%26lt%3Bdiv%20class%3D%26quot%3Bcsl-bib-body%26quot%3B%20style%3D%26quot%3Bline-height%3A%201.35%3B%20%26quot%3B%26gt%3B%5Cn%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-entry%26quot%3B%20style%3D%26quot%3Bclear%3A%20left%3B%20%26quot%3B%26gt%3B%5Cn%20%20%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-left-margin%26quot%3B%20style%3D%26quot%3Bfloat%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%26quot%3B%26gt%3B1.%20%26lt%3B%5C%2Fdiv%26gt%3B%26lt%3Bdiv%20class%3D%26quot%3Bcsl-right-inline%26quot%3B%20style%3D%26quot%3Bmargin%3A%200%20.4em%200%201.5em%3B%26quot%3B%26gt%3BFlythe%20JE%2C%20Kimmel%20SE%2C%20Brunelli%20SM.%20Rapid%20fluid%20removal%20during%20dialysis%20is%20associated%20with%20cardiovascular%20morbidity%20and%20mortality.%20%26lt%3Bi%26gt%3BKidney%20Int%26lt%3B%5C%2Fi%26gt%3B.%202011%3B79%282%29%3A250-257.%20%26lt%3Ba%20class%3D%26%23039%3Bzp-DOIURL%26%23039%3B%20target%3D%26%23039%3B_blank%26%23039%3B%20rel%3D%26%23039%3Bnoopener%20noreferrer%26%23039%3B%20href%3D%26%23039%3Bhttp%3A%5C%2F%5C%2Fdoi.org%5C%2F10.1038%5C%2Fki.2010.383%26%23039%3B%26gt%3Bhttp%3A%5C%2F%5C%2Fdoi.org%5C%2F10.1038%5C%2Fki.2010.383%26lt%3B%5C%2Fa%26gt%3B%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%20%20%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%26lt%3B%5C%2Fdiv%26gt%3B%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22Rapid%20fluid%20removal%20during%20dialysis%20is%20associated%20with%20cardiovascular%20morbidity%20and%20mortality%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Jennifer%20E.%22%2C%22lastName%22%3A%22Flythe%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Stephen%20E.%22%2C%22lastName%22%3A%22Kimmel%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Steven%20M.%22%2C%22lastName%22%3A%22Brunelli%22%7D%5D%2C%22abstractNote%22%3A%22Patients%20receiving%20hemodialysis%20have%20high%20rates%20of%20cardiovascular%20morbidity%20and%20mortality%20that%20may%20be%20related%20to%20the%20hemodynamic%20effects%20of%20rapid%20ultrafiltration.%20Here%20we%20tested%20whether%20higher%20dialytic%20ultrafiltration%20rates%20are%20associated%20with%20greater%20all-cause%20and%20cardiovascular%20mortality%2C%20and%20hospitalization%20for%20cardiovascular%20disease.%20We%20used%20data%20from%20the%20Hemodialysis%20Study%2C%20an%20almost-7-year%20randomized%20clinical%20trial%20of%201846%20patients%20receiving%20thrice-weekly%20chronic%20dialysis.%20The%20ultrafiltration%20rates%20were%20divided%20into%20three%20categories%3A%20up%20to%2010%20ml%5C%2Fh%5C%2Fkg%2C%2010%5Cu201313%20ml%5C%2Fh%5C%2Fkg%2C%20and%20over%2013%20ml%5C%2Fh%5C%2Fkg.%20Compared%20to%20ultrafiltration%20rates%20in%20the%20lowest%20group%2C%20rates%20in%20the%20highest%20were%20significantly%20associated%20with%20increased%20all-cause%20and%20cardiovascular-related%20mortality%20with%20adjusted%20hazard%20ratios%20of%201.59%20and%201.71%2C%20respectively.%20Overall%2C%20ultrafiltration%20rates%20between%2010%5Cu201313%20ml%5C%2Fh%5C%2Fkg%20were%20not%20associated%20with%20all-cause%20or%20cardiovascular%20mortality%3B%20however%2C%20they%20were%20significantly%20associated%20among%20participants%20with%20congestive%20heart%20failure.%20Cubic%20spline%20interpolation%20suggested%20that%20the%20risk%20of%20all-cause%20and%20cardiovascular%20mortality%20began%20to%20increase%20at%20ultrafiltration%20rates%20over%2010%20ml%5C%2Fh%5C%2Fkg%20regardless%20of%20the%20status%20of%20congestive%20heart%20failure.%20Hence%2C%20higher%20ultrafiltration%20rates%20in%20hemodialysis%20patients%20are%20associated%20with%20a%20greater%20risk%20of%20all-cause%20and%20cardiovascular%20death.%22%2C%22date%22%3A%222011-1%22%2C%22language%22%3A%22%22%2C%22DOI%22%3A%2210.1038%5C%2Fki.2010.383%22%2C%22ISSN%22%3A%220085-2538%22%2C%22url%22%3A%22http%3A%5C%2F%5C%2Fwww.ncbi.nlm.nih.gov%5C%2Fpmc%5C%2Farticles%5C%2FPMC3091945%5C%2F%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-03-28T08%3A58%3A26Z%22%7D%7D%5D%7D
1.
Saran R, Bragg-Gresham JL, Levin NW, et al. Longer treatment time and slower ultrafiltration in hemodialysis: Associations with reduced mortality in the DOPPS. Kidney Int. 2006;69(7):1222-1228. http://doi.org/10.1038/sj.ki.5000186
1.
Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250-257. http://doi.org/10.1038/ki.2010.383