Automatic Adaptive System Dialysis for Hemodialysis-Associated Hypotension and Intolerance: A Noncontrolled Multicenter Trial

作者：Coli Luigi; La Manna Gaetano; Comai Giorgia; Ursino Mauro; Ricci Davide; Piccari Matteo; Locatelli Francesco; Di Filippo Salvatore; Cristinelli Luciano; Bacchi Massimo; Balducci Alessandro; Aucella Filippo; Panichi Vincenzo; Ferrandello Francesco Paolo; Tarchini Renzo; Lambertini Domenica; Mura Carlo; Marinangeli Giancarlo; Di Loreto Ermanno; Quarello Francesco; Forneris Giacomo; Tancredi Maurizio; Morosetti Massimo; Palombo Giuditta; Di Luca Marina; Martello Mauro

来源：American Journal of Kidney Diseases, 2011, 58(1): 93-100.

DOI：10.1053/j.ajkd.2011.01.030

• Hemodialysis
• hypotension
• profiler
• sodium

Background: Hemodialysis is complicated by a high incidence of intradialytic hypotension and disequilibrium symptoms caused by hypovolemia and a decrease in extracellular osmolarity. Automatic adaptive system dialysis (AASD) is a proprietary dialysis system that provides automated elaboration of dialysate and ultrafiltration profiles based on the prescribed decrease in body weight and sodium content.
Study Design: A noncontrolled (single arm), multicenter, prospective, clinical trial.
Setting & Participants: 55 patients with intradialytic hypotension or disequilibrium syndrome in 15 dialysis units were studied over a 1-month interval using standard treatment (642 sessions) followed by 6 months using AASD (2,376 sessions).
Intervention: AASD (bicarbonate dialysis with dialysate sodium concentration and ultrafiltration rate profiles determined by the automated procedure).
Outcomes: Primary and major secondary outcomes were the frequency of intradialytic hypotension and symptoms (hypotensive events, headache, nausea, vomiting, and cramps), respectively.
Results: More stable intradialytic systolic and diastolic blood pressures with lower heart rate were found using AASD compared with standard treatment. Sessions complicated by hypotension decreased from 58.7% +/- 7.3% to 0.9% +/- 0.6% (P < 0.001). The incidence of other disequilibrium syndrome symptoms was lower in patients receiving AASD. There were no differences in end-session body weight, interdialytic weight gain, or presession natremia between the standard and AASD treatment periods.
Limitations: A noncontrolled (single arm) study, no crossover from AASD to standard treatment.
Conclusions: This study shows the long-term clinical efficacy of AASD for intradialytic hypotension and disequilibrium symptoms in a large number of patients and dialysis sessions. Am J Kidney Dis. 58(1):93-100.

• 出版日期2011-7