Prevention Of Dialysis Disequilibrium Syndrome By Use Of Low Dialysate Flow And Low Blood Flow

Objectives: To observe the prevention effect of the dialysis method which is low dialysate flow and low blood flow dialysis to the dialysis disequilibrium syndrome for the first time dialysis patient.Methods: 85 patients received hemodialysis for the first time in the blood purification center of Xiangya the second hospital of central south university from November 2008 to February 2009. The 85 patients were randomly divided into experimental group (A group ) and control group (B group). Dialysis method for the experimental group: Dialysate flow 300ml/min, blood flow 150ml/min, dialysis last for 3 hours. Dialysis method for the control group: Dialysate flow 500ml/min, blood flow 250ml/min, dialysis last for 2 hours. Vital signs and clinical symptoms were observed during dialysis and 24 hours after dialysis and the symptoms of dialysis disequilibrium syndrome were assessed if it occurred. The concentration of blood sodium, blood potassium, blood glucose, urea nitrogen and creatinine were examined before and after the dialysis. The urea nitrogen clearance rate, the urea nitrogen clearance rate speed, the osmotic pressure, the osmotic pressure volume change and the osmotic pressure volume change speed were all calculated. Compare the incidence of the dialysis disequilibrium syndrome between the experimental group and the control group. Results: The main symptoms of dialysis disequilibrium were dizziness, headache, nausea, vomiting, hypertension, blurred vision, irritability, disorientation etc. Just 2 cases in 42cases occurred mild dialysis disequilibrium syndrome in experimental group, the main symptoms were headache, vomiting, the incidence rate was only 4.76%, but 7 cases in 43 cases were occurred mild dialysis disequilibrium syndrome and 1case had blurred vision and disorientation , which belonged to moderate dialysis disequilibrum in control group, the incidence rate was 18.6%. The dialysis method of experimental group could significantly decrease the occurrence of dialysis disequilibrium syndrome (P<0. 05). The urea nitrogen and creatinine concentration in both experimental group and control group had no difference before the dialysis (P<0. 05). The urea nitrogen clearance rate did not have any significant difference between the two groups (P>0.05). But between the experimental group and the control group , the urea nitrogen clearance rate speed had significant difference (P<0.01). The osmotic pressure volume change also didn't have any difference between the experiment group and the control group (P>0.05). And the osmotic pressure volume change speed in the experimental group was more slowly than in control group (P<0.05). The osmotic pressure volume change of a lot of people who didn't occurred dialysis disequilibrium syndrome in the experimental group was similar to some people who occurred dialysis disequilibrium syndrome in the control group (P<0.05). The difference of the two was the osmotic pressure volume change speed in the experimental group was more slowly than control group (P<0.05). Which illustrated that the osmotic pressure in the experimental group decreased more smoothly than the control group, The osmotic pressure gradient between brain and plasma was fewer in experimental group, then the probability of cerebral edema was less. There were the evidence that the experimental method could effectively prevented dialysis disequilibrium syndrome occurs.Conclusions: The method of low dialysate flow and low blood flow dialysis could clear urea nitrogen et al. in plasma more slowly, then decreased osmotic pressure more slowly, which could lead the osmotic pressure gradient less between the brain and the plasma, then reduce cerebral edema occurred. This method could effectively prevent the dialysis disequilibrium syndrome occurred and did not affect the clearance of the urea nitrogen. At the same time, which the osmotic pressure volume change lead dialysis disequilibrium syndrome was the apparent reason, and the osmotic pressure volume change speed was the root cause of the dialysis disequilibrium syndrome. For the first time received dialysis and the induction period of dialysis, the low dialysate flow and low blood flow dialysis method was a effective and new way to prevent the dialysis disequilibrium syndrome, this new method didn't found any complication more than general dialysis.