Publication: Farklı diyalizat sodyumu ve basamaklı ultrafiltrasyonun hemodiyalizdeki komplikasyonlara etkisi
Abstract
Hemodiyaliz (HD) deki ilerlemelere rağmen hipotansiyon, kas krampları, bulantı-kusma, baş ağrısı, baş dönmesi ve halsizlik hissi gibi HD komplikasyonları sorun olmaya devam etmektedir. Bu çalışma farklı sodyum (Na) konsantrasyonlu diyalizat ve basamaklı ultrafiltrasyon uygulamalarının HD sırasında ortaya çıkan komplikasyonlar üzerine etkilerini araştırmak amacıyla deneysel olarak yapıldı. Araştırmanın evrenini; İstanbul il sınırları içinde bulunan, Özel Çapa Diyaliz Merkezinde haftada 3 kez HD tedavisi alan 90 HD hastası oluşturdu. Örneklem grubunu ise HD sırasında hipotansiyon, kramp, bulantı-kusma, baş ağrısı, baş dönmesi, halsizlik hissi gibi komplikasyonlar yaşayan ve çalışmaya katılmayı kabul eden 40 HD hastası oluşturdu. Araştırma 1 Ekim 2003 - 1 Şubat 2004 tarihleri arasında yapıldı. Olgulara birer aylık sürelerde standart HD (diyalizat Na' u 140mEq/ L ve sabit UF) ile üç farklı HD protokolü uygulandı. Bu protokoller; Protokol 1: Basamaklı diyalizat Na'u, sabit UF, Protokol 2: Basamaklı diyalizat Na'u, basamaklı UF, Protokol 3: Sabit diyalizat Na'u, basamaklı UF, Protokol 4 (Standart HD): Sabit diyalizat Na'u, sabit UF. Standart HD ve diğer protokollerin hepsinde hastalara bikarbonat diyalizi uygulandı ve diyalizat ısısı 360C' de sabit tutuldu. Araştırmada veri toplama aracı olarak literatür bilgisi doğrultusunda araştırmacı tarafından hazırlanan hasta takip formu kullanıldı. Çalışmanın verileri, bilgisayarda SPSS programında aritmetik ortalama, yüzdelik, t-testi ve Mc-Neamer testleri kullanılarak değerlendirildi. Standart HD'ye göre olguların hipotansiyon, kramp, bulantı-kusma, baş dönmesi ve halsizlik gibi HD komplikasyonlarını en az protokol 2'de yaşadığı görüldü. Standart HD'ye göre komplikasyonlara yönelik yapılan hemşirelik uygulamalarına en az protokol 2'de ihtiyaç duyuldu. Buna göre; HD sırasında hipotansiyon, kramp, bulantı-kusma, baş ağrısı, baş dönmesi ve halsizlik hissi gibi komplikasyonların sık görüldüğü hastalara basamaklı diyalizat Na'u ve basamaklı UF yapılması önerildi. THE EFFECTS OF DIALYSATES WITH DIFFERENT SODIUM CONCENTRATIONS AND GRADIENT ULTRAFILTRATION PRACTICES ON HEMODIALYSIS COMPLICATIONS
Despite advances in hemodialysis (HD), such as complications hypotension, muscle cramps, nausea-vomiting, headache and weakness still cause problems. In this study, we aimed to investigate experimentally the effects of dialysates with different sodium concentrations and gradient ultrafiltration practices on the hemodialysis complications. The study population was 90 HD patients living in Istanbul, who were treated 3 times a week at the Çapa private dialysis center. Forty patients who had been experiencing hypotension, muscle cramps, nausea and vomiting, headache, vertigo, fatigue during HD and who accepted to participate were included into the study group. The study was carried out between October 1st 2003 and February 1st 2004. All patients were administered 4 different HD protocols consecutively, each for 1 month duration. These protocols were: Protocol 1: Gradient sodium dialysate, constant UF; Protocol 2: Gradient sodium dialysate, gradient UF; Protocol 3: Constant sodium dialysate, gradient UF; Protocol 4 (standard HD): constant sodium dialysate (dialysate with 140 mEq/ L Na+), constant UF. In the gradient sodium dialysate, the beginning Na+ concentration was 150 mEq/ L. This concentration was decreased by 4 mEq/ L at each hour, till it was 138 mEq/ L during the last hour of dialysis. In the gradient ultrafiltration, 2/ 3rd of the volume was taken back during the first two hours and the resting 1/ 3rd, during the last 2 hours of the HD treatment. In all protocols, bicarbonate dialysis were administered and the temperature of the dialysate was kept constant at 360C. A patient follow-up form, prepared by the researcher according to the recent literature, was used to gather the data. The data were analyzed using SPSS for Windows; means, percentages were calculated, t-test and Mc-Neamar tests used in statistical analysis. When compared with the standard HD, it is found that patients had experienced the least number of HD complications with protocol 2. Moreover, nurse intervention for complications were significantly less needed with protocol 2 (p<0.05). In conclusion, it is advisable to administer gradient Na dialysate and gradient UF during HD in patients experiencing frequent complications.
Despite advances in hemodialysis (HD), such as complications hypotension, muscle cramps, nausea-vomiting, headache and weakness still cause problems. In this study, we aimed to investigate experimentally the effects of dialysates with different sodium concentrations and gradient ultrafiltration practices on the hemodialysis complications. The study population was 90 HD patients living in Istanbul, who were treated 3 times a week at the Çapa private dialysis center. Forty patients who had been experiencing hypotension, muscle cramps, nausea and vomiting, headache, vertigo, fatigue during HD and who accepted to participate were included into the study group. The study was carried out between October 1st 2003 and February 1st 2004. All patients were administered 4 different HD protocols consecutively, each for 1 month duration. These protocols were: Protocol 1: Gradient sodium dialysate, constant UF; Protocol 2: Gradient sodium dialysate, gradient UF; Protocol 3: Constant sodium dialysate, gradient UF; Protocol 4 (standard HD): constant sodium dialysate (dialysate with 140 mEq/ L Na+), constant UF. In the gradient sodium dialysate, the beginning Na+ concentration was 150 mEq/ L. This concentration was decreased by 4 mEq/ L at each hour, till it was 138 mEq/ L during the last hour of dialysis. In the gradient ultrafiltration, 2/ 3rd of the volume was taken back during the first two hours and the resting 1/ 3rd, during the last 2 hours of the HD treatment. In all protocols, bicarbonate dialysis were administered and the temperature of the dialysate was kept constant at 360C. A patient follow-up form, prepared by the researcher according to the recent literature, was used to gather the data. The data were analyzed using SPSS for Windows; means, percentages were calculated, t-test and Mc-Neamar tests used in statistical analysis. When compared with the standard HD, it is found that patients had experienced the least number of HD complications with protocol 2. Moreover, nurse intervention for complications were significantly less needed with protocol 2 (p<0.05). In conclusion, it is advisable to administer gradient Na dialysate and gradient UF during HD in patients experiencing frequent complications.