Metabolismo y Actividad Autonómica en Hemodiafiltración Controlando la Temperatura del Líquido de Diálisis en Forma Fija y Dinámica

摘要

Accumulation of heat is an important problem during hemodiafiltration therapy (HDF), which has the potential to lead patients to hypotension. Control of the dialysate's temperature can reduce hypotension events probability when one of the different equipment thermodynamic modalities is correctly selected. Isothermal, thermoneutral and fixed temperatures @ 35 or 37 °C are available to increase each patient's hemodynamic stability but previous studies have not well defined Which one is the right? The hypothesis is that monitoring metabolism and autonomic nervous system (ANS) activities can provide information to determine the benefits of each modality. Therefore, the aim of this work was to study stable patients' populations but only with chronic kidney decease. The methodology was to measure energy expenditure (GE) by indirect calorimetry and ANS activity using heart rate variability (HRV). A group of 10 patients were assessed in an across study using 35°C and then 37°C fixed modality. Other 6 patients underwent isothermal and then normothermal modalities. In both populations equally observational times were defined. Tl before the HDF therapy was initiated, T2 after 90 minutes and T3 at the end of HDF therapy. One way ANOVA stadistical analysis was implemented to observe the 3 time stage changes, accepting differences when p< 0.1 since the study was considered as a pilot. The results showed not significant diastolic pressure drops changes except during 37°C modality (p<0.05). The sympatho-vagal index (ISV) was increased significantly only at 35°C as well as the GE and the most significant temperature increase occurs at 37°C (p<0.05). The conclusion is that ISV and GE appear partially sensitive to the type of modality in use. However more patients should be analyzed to continue with this research.