【摘要】目的维持性血液透析(MHD)患者心血管发病率及死亡率高，其危险因素包括水负荷过重，临
床上常表现为透析间期体质量增长(IDWG)过多。钠梯度为透析液钠浓度与透析前血清钠浓度的差值，本
研究拟研究钠梯度与MHD 患者水负荷关系。方法选取2013 年3～12 月在四川省人民医院血液净化
中心维持性血液透析的患者81 例，血液透析3 次/周，尿量＜500ml/天。收集患者期间透析前及透析后血
清钠数据、钠梯度、IDWG、IDWG%及透析中低血压的发生率。结果所有患者透析前血清钠浓度为
[138.81±3.27(130.2～145.0)]mmol/L，透析后血清钠浓度为[137.81±2.88(132.5～146.0)]mmol/L，
透析液钠浓度为135mmol/L，钠梯度绝对值为[3.92±2.69(0～10.0)]mmol/L，透析前后钠浓度差绝对值
[2.79±2.14(0.1～8.6)]mmol/L，IDWG 为[2.06±0.82(0.50～4.20)]kg，IDWG%为[3.71±1.42(1.01～
8.42)]%。钠梯度绝对值与IDWG 及IDWG%均显著相关(r=0.349，P=0.001；r=0.269，P=0.013)，钠梯度绝对
值为0 时，MHD 患者IDWG 最低，透析对患者的钠负荷及水负荷影响最小。年龄与透析前钠浓度、钠梯度绝
对值、IDWG 及IDWG%显著负相关。低血压的发生率与钠梯度绝对值、IDWG 等无显著相关。结论维持
性血液透析患者钠梯度绝对值与IDWG 显著正相关，对MHD 患者透析液钠浓度的个体化处方，可能改善
MHD 患者的水负荷。

【Abstract】Background Maintenance hemodialysis (MHD) patients are associated with higher incidence
of cardiovascular morbidity and mortality, for which the risk factors include hypertension, overhydration, etc.
More interdialytic weight gain (IDWG) usually reflects water overload in MHD patients. Sodium gradient is
defined as the difference of sodium concentration in dialysate and in predialysis serum. We hypothesize that
lower absolute sodium gradient is associated with lower IDWG, and try to figure out the correlation of sodium
gradient with water load and interdialytic hypotention in MHD patients. Methods We conducted a retrospective
study on 81 MHD patients in our hemodialysis center from Mar. to Dec. in 2013. Basic clinic data, predialysis
and postdialysis serum sodium concentrations, sodium gradient, IDWG, IDWG% (IDWG/dry body
weight×100%), and the prevalence of interdialytic hypotension were recorded and analyzed. Results The dialysate
sodium was 135 mmol/L for all patients, and the predialytic serum sodium was 138.81±3.27 (130.2～
145.0) mmol/L with the absolute sodium gradient of 3.92±2.69 (0～10.0) mmol/L. IDWG and IDWG% were
2.06±0.82 (0.50～4.20) kg, and 3.71±1.42 (1.01～8.42) %, respectively. The absolute sodium gradient was
positively correlated with IDWG (r=0.349, P=0.001) and IDWG% (r=0.269, P=0.013). The incidence of interdialytic
hypotension had no significant correlation with absolute sodium gradient and IDWG. Age was negatively
correlated with predialysis serum sodium, absolute sodium gradient, IDWG and IDWG%. Conclusions
The absolute sodium gradient was directly associated with IDWG, and higher absolute sodium gradient was
associated with higher IDWG. Individualized sodium concentration in dialysate for each MHD patient may be
useful for the prevention of overhydration in MHD patients.