PDF(Pubmed)
Abstract：
BACKGROUND: Cardiovascular diseases are the dominant cause of morbidity in hemodialysis (HD) patients. Unless sufficient anticoagulation is used during HD, clotting may appear. The objective was to investigate if levels of fibrin degradation products (D-dimer) were increased before and during HD.
METHODS: The combined observational study included 20 patients performing a total of 60 hemodialysis divided into three sessions of low-flux dialysis. None of the patients suffered from any clinically evident thromboembolic event before or during the study. Median bolus anticoagulation (mainly tinzaparin) doses were 84 Units/kg bow. Blood samples were drawn before HD (predialysis), and at 30min and 180min during HD with focus on analyzing D-dimer levels and its relation to interdialytic weight gain (IDWG) and speed of fluid elimination by HD (UF-rate).
RESULTS: Predialysis, D-dimer levels (mean 0.767 ±0.821, min 0.136mg/L) were above the upper reference value in 95% of the sessions. D-dimer levels were lowered at 30min (p<0.001) and returned to predialysis levels at 180min. Predialysis D-dimer correlated with NT-pro-BNP, Troponin T, IDWG and UF-rate. Multiple regression analysis revealed that the D-dimer levels were significantly related to IDWG and the UF-rate.
CONCLUSIONS: D-dimer levels were elevated in a high proportion predialysis and during HD and related to the IDWG and the UF-rate. Awareness of D-dimer levels and future studies will help clarify if optimization of those variables, besides anticoagulation and biocompatibility measures, will eradicate the repeated subclinical thromboembolic events related to each HD; one reason that may explain organ damage and shortened life span of these patients.
METHODS: The combined observational study included 20 patients performing a total of 60 hemodialysis divided into three sessions of low-flux dialysis. None of the patients suffered from any clinically evident thromboembolic event before or during the study. Median bolus anticoagulation (mainly tinzaparin) doses were 84 Units/kg bow. Blood samples were drawn before HD (predialysis), and at 30min and 180min during HD with focus on analyzing D-dimer levels and its relation to interdialytic weight gain (IDWG) and speed of fluid elimination by HD (UF-rate).
RESULTS: Predialysis, D-dimer levels (mean 0.767 ±0.821, min 0.136mg/L) were above the upper reference value in 95% of the sessions. D-dimer levels were lowered at 30min (p<0.001) and returned to predialysis levels at 180min. Predialysis D-dimer correlated with NT-pro-BNP, Troponin T, IDWG and UF-rate. Multiple regression analysis revealed that the D-dimer levels were significantly related to IDWG and the UF-rate.
CONCLUSIONS: D-dimer levels were elevated in a high proportion predialysis and during HD and related to the IDWG and the UF-rate. Awareness of D-dimer levels and future studies will help clarify if optimization of those variables, besides anticoagulation and biocompatibility measures, will eradicate the repeated subclinical thromboembolic events related to each HD; one reason that may explain organ damage and shortened life span of these patients.
摘要：
背景：心血管疾病是血液透析（HD）患者发病的主要原因。除非在HD期间使用足够的抗凝药物,可能会出现凝血。目的是研究在HD之前和期间纤维蛋白降解产物(D-二聚体)的水平是否增加。
方法：联合观察性研究包括20名患者，共进行60次血液透析，分为3次低流量透析。在研究之前或研究期间，没有患者发生任何临床上明显的血栓栓塞事件。平均推注抗凝（主要是丁扎肝素）剂量为84单位/kg弓。在HD（透析前）前抽取血样，在HD过程中30分钟和180分钟，重点分析D-二聚体水平及其与透析间体重增加（IDWG）和HD消除液体的速度（UF速率）的关系。
结果：透析前，在95％的会议中，D-二聚体水平（平均0.767±0.821，min0.136mg/L）高于上参考值。D-二聚体水平在30分钟时降低(p<0.001),并在180分钟时恢复到透析前水平。透析前D-二聚体与NT-pro-BNP相关,肌钙蛋白T,IDWG和UF费率。多元回归分析显示，D-二聚体水平与IDWG和UF率显着相关。
结论：D-二聚体水平在高比例透析前和HD期间升高，并且与IDWG和UF率相关。对D-二聚体水平的认识和未来的研究将有助于澄清这些变量的优化，除了抗凝和生物相容性措施，将根除与每次HD相关的重复亚临床血栓栓塞事件;一个可以解释这些患者器官损伤和寿命缩短的原因。
方法：联合观察性研究包括20名患者，共进行60次血液透析，分为3次低流量透析。在研究之前或研究期间，没有患者发生任何临床上明显的血栓栓塞事件。平均推注抗凝（主要是丁扎肝素）剂量为84单位/kg弓。在HD（透析前）前抽取血样，在HD过程中30分钟和180分钟，重点分析D-二聚体水平及其与透析间体重增加（IDWG）和HD消除液体的速度（UF速率）的关系。
结果：透析前，在95％的会议中，D-二聚体水平（平均0.767±0.821，min0.136mg/L）高于上参考值。D-二聚体水平在30分钟时降低(p<0.001),并在180分钟时恢复到透析前水平。透析前D-二聚体与NT-pro-BNP相关,肌钙蛋白T,IDWG和UF费率。多元回归分析显示，D-二聚体水平与IDWG和UF率显着相关。
结论：D-二聚体水平在高比例透析前和HD期间升高，并且与IDWG和UF率相关。对D-二聚体水平的认识和未来的研究将有助于澄清这些变量的优化，除了抗凝和生物相容性措施，将根除与每次HD相关的重复亚临床血栓栓塞事件;一个可以解释这些患者器官损伤和寿命缩短的原因。
