Hemodialysis Associated Hypoxia Extends into the Post-Dialysis Period

Dhakal, Madhavendra P.; Kallay, Michael C.; Talley, Thomas E.

doi:10.1177/039139889702000403

Cited by 14 publications

(12 citation statements)

References 10 publications

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“…Those with diabetes demonstrated a significantly higher median relative blood flow at 6 mm tissue depth [25 vs. 14 arbitrary units (AU) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14); P = 0.048] at baseline compared with the non-diabetic group (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

et al. 2009

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Aims To examine the cutaneous microcirculation on the dorsum of the foot before, during and after haemodialysis in diabetic and non-diabetic patients. MethodsFourteen age-matched patients (seven diabetic, seven non-diabetic) without active foot ulceration were studied. Cutaneous microcirculation was assessed using a micro-lightguide spectrophotometer to measure venous oxygen saturation and relative blood flow determined at two tissue depths: 2 and 6 mm. Cumulative relative changes of each parameter during haemodialysis were calculated as area under the curve. Differences between and within the groups were calculated by Mann-Whitney U -test and ANOVA following post hoc testing, respectively.Results At baseline, relative blood flow at 6 mm tissue depth was significantly greater in diabetic patients ( P = 0.048). Thirty minutes after the end of dialysis, relative blood flow at 2 and 6 mm tissue depth was significantly higher in nondiabetic patients ( P = 0.048 and P = 0.001). Mean cumulative relative changes in venous oxygen saturation and relative blood flow at 2 mm as well as 6 mm tissue depth were positive for non-diabetic subjects and negative for diabetic patients. ConclusionsHaemodialysis is associated with changes in cutaneous microcirculation, which differ between people with and without diabetes. In those without diabetes, we found an increase in blood flow during haemodialysis, whereas blood flow was reduced in diabetic patients. This may be the result of abnormal vasomotor regulation due to distal neuropathy. Diabet. Med. 26, 89-92 (2009)

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Section: Resultsmentioning

confidence: 99%

“…It has been suggested that the increase in incidence of new foot ulcers may be in part the result of haemodialysis itself [2]. It has been known for many years that haemodialysis is associated with generalized hypoxaemia [4][5][6][7], but the cause is not clear.…”

Section: Introductionmentioning

confidence: 99%

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

et al. 2009

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“…The latter is thought to occur due to various factors, including pulmonary microatelectasis, the activation of complement, and a change in the oxygen dissociation curve. [62] Nonetheless, the direct effect of hemodialysis should not lead to an underestimation of perturbations associated with diabetes. [63,64] Among patients with various kidney diseases requiring dialysis, diabetes significantly increases the risk for amputation by 2.51-6.4.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

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“…Hypoxia during HD has been previously reported, and it is usually attributed to acetate and sometimes, a bicarbonate bath (29)(30)(31). However, an important component driving hypoxia could be volume overload.…”

Section: Discussionmentioning

confidence: 99%

Determinants and Short-Term Reproducibility of Relative Plasma Volume Slopes during Hemodialysis

Anand

Sinha

Agarwal

2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Hypervolemia is a major cause of morbidity, in part because of the lack of well characterized diagnostic tests. The hypothesis was that relative plasma volume (RPV) slopes are influenced by ultrafiltration rate, directly associate with improvement in arterial oxygen saturation, and are reproducible.Design, setting, participants, & measurements RPV slopes were measured on three consecutive hemodialysis sessions. Various relationships were tested using mixed models. Reproducibility was assessed by the intraclass correlation coefficient.Results RPV slopes averaged 1.3761.45% per hour. The mean RPV slopes were steeper on the first dialysis of the week, which correlated with a higher ultrafiltration rate; RPV slope and ultrafiltration rate were directly related. Increasing ultrafiltration rate quartiles were associated with similar change in RPV in the first 1 hour of dialysis but steeper changes in RPV subsequently. A direct relationship emerged between increasing RPV slopes and increasing arterial oxygen saturation slopes. The intraclass correlation coefficient for the relative plasma volume slope was 0.77.Conclusions Although ultrafiltration rate is a major determinant of RPV slope, similar ultrafiltration rates are associated with varying RPV between individuals. Because RPV is associated with little change by ultrafiltration rate during the first 1 hour of dialysis, probing dry weight during the earlier part of dialysis may be safer. RPV slopes are physiologically meaningful, because they are associated with parallel changes in arterial oxygenation saturation slopes. RPV slopes are reproducible, and therefore, RPV may serve as a useful marker to judge changes in volume status within an individual.

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Hemodialysis Associated Hypoxia Extends into the Post-Dialysis Period

Cited by 14 publications

References 10 publications

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

The Diabetic Foot in End Stage Renal Disease

Determinants and Short-Term Reproducibility of Relative Plasma Volume Slopes during Hemodialysis

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