血液透析導入初期における心胸比を用いた目標体重の概算法

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  • A rough estimate of dry weight by CTR in the initial period of hemodialysis therapy.

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In order to estimate the optimal dry weight (DW) in the initial period of hemodialysis therapy (ipHD), the relationship between cardiothoracic ratio (CTR) and excess body fluid for ultra-filtration (UF) was investigated. A few cases of overhydration were found among patients with end-stage renal disease (ESRD) caused by polycystic kidney, and the poor reliability of CTR at DW was investigated in ESRD patients with cardiac disease. In 154 patients, excluding patients with the above types of ESRD, the difference between CTR immediately before the start of HD (bsHD) and CTR after the interval required for DW to be attained (ΔCTR) was analyzed in relation to the percent decrease in body weight (ΔBW) in the same period.<br>A significant correlation was found between ΔCTR and ΔBW (r=0.63, p<0.025) only in ESRD with a bsHD CTR over 50%. From this correlation, the UF volume for reaching optimal DW in ipHD for overhydration ESRD with CTR over 50% is deduced from following equation: UF volume (1)=bsHD body weight×{1.28 (bsHD CTR-50)+1.3}÷100 (1). Using this, ipHD DW estimation was applied to 6 ESRD patients and was found to be applicable for reaching optimal DW in 6 hemodialysis therapies. The first three achieved 60% of target UF while the last three established 80-100% of target UF, while blood pressure and clinical symptoms were monitored.

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