Hemodynamic Studies in Chronic Uremia

Background: The cause of blood pressure (BP) changes during uncomplicated hemodialysis (HD) has not been fully investigated. Controversy exists whether changes in BP result from changes in stroke volume (SV) or total peripheral resistance (TPR). Methods: We investigated 19 patients using continuous BP monitoring (Portapres^®) and subsequent Modelflow^® analysis, yielding continuous SV, cardiac output (CO) and TPR values. Blood volume (BV) monitoring was also performed. For each patient, the sensitivity index (SI) was calculated. The SI is the slope of the curve depicting the relationship between the systolic BP (SBP) response and the BV response. The patients were divided into two groups: group A had an SI >1 which means a decrease in SBP in response to BV change, and group B had an SI <1. In these patients, SBP remained stable despite a BV change. Results: Baseline characteristics and baseline values of all parameters were similar between the groups. In group A, SBP decreased by 25 ± 19 mm Hg and in group B the SBP increased by 5.0 ± 29 mm Hg (p < 0.05), while BV change was similar (10.6 ± 4.9 and 11.2 ± 4.2%, respectively). The difference in SBP response was caused by a different SV response (group A –44 ± 16% and group B –26 ± 18%, p = 0.04), while the TPR response was similar (71 ± 27% in group A vs. 59 ± 58% in group B). Conclusion: Patients responding with a BP decrease to BV reduction during uncomplicated HD differ in their SV response from patients with a stable BP.

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“…was found. This increase in heart rate agrees with other studies investigating hemodynamics during HD [4, 14, 15, 16]. …”

Section: Discussionsupporting

confidence: 92%

Blood Pressure Response to Uncomplicated Hemodialysis: The Importance of Changes in Stroke Volume

et al. 2004

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“…Measurement of cardiac output by indicator dye dilution or from plasma volume changes produced variable results (17,18). While Goss et al (7) reported a reduction in cardiac output, subsequent studies after hemodialysis by DelGreco et al (8) showed a fall in cardiac output in patients without congestive heart failure compared to an increased cardiac output in patients with associated congestive heart failure.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier human studies of hemodynamic changes after hemodialysis in patients with chronic renal failure were confined to the demonstration of alterations in cardiac output, heart rate, systemic arterial pressure, and peripheral vascular resistance (7)(8)(9)(10)(11). The advent of noninvasive techniques has permitted a more comprehensive evaluation of left ventricular function in patients in chronic renal failure and of the effects of hemodialysis (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

Nixon¹,

Mitchell²,

McPhaul³

et al. 1983

J. Clin. Invest.

100

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A B S T R A C T Prior studies of the effect of hemodialysis on left ventricular function have not distinguished between the removal of uremic toxins and the change in cardiac filling volume. To separate these effects, left ventricular function was examined by serial echocardiography in five stable hemodialysis patients before and after three different dialysis procedures: (a) hemodialysis with volume loss, (b) ultrafiltration (volume loss only), and (c) hemodialysis without volume loss. The patients were similarly studied under control conditions and after increased (50 of headdown tilt for 90 min) and decreased (lower body negative pressure) cardiac filling volume.After hemodialysis with volume loss, end-diastolic volume (EDV) decreased from 167 to 128 ml (P < 0.001) and end-systolic volume (ESV) decreased from 97 to 51 ml (P < 0.001) without a change in stroke volume (SV). Ejection fraction increased from 42 to 52% (P < 0.001) and mean velocity of circumferential fiber shortening (VCF) increased from 0.61 to 1.04 circumferences (circ)/s (P < 0.001). After ultrafiltration, EDV decreased from 167 ml to 124 ml (P < 0.001) and SV from 73 ml to 39 ml (P < 0.001), without significant changes in ESV or VCF. In contrast to the maneuvers in which volume loss occurred, after hemodialysis without volume loss ESV decreased from 95 to 66 ml (P < 0.001) and SV increased from 74 ml to 97 ml (P < 0.001) without changes in EDV. EF increased from 44 to 59% (P < 0.001) and VCF increased from 0.64 to 1.26 circ/s (P < 0.001). Ventricular function curves plotted from data obtained under conditions of altered cardiac filling volume before and after the three dialysis maneuvers demonstrate that ultrafiltration produced a pure Frank-Starling effect, while Received for publication 9 March 1982 and in revised form 23 August 1982. hemodialysis with or without volume loss produced a shift in the ventricular function curves, which demonstrated an increase in the contractile state of the left ventricle. The changes in left ventricular function produced by regular hemodialysis are the combined effects of a decrease in EDV and an increase in the contractile state of the left ventricle.

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“…Adanya perbedaan yang bermakna pada penelitian ini dikarenakan peningkatan cardiac output oleh beberapa mekanisme seperti penurunan volume overload cairan ekstraselular, penurunan resistensi vaskuler perifer, dan pengeluaran toksin uremik yang menjadi faktor cardiopressor. Hal tersebut sesuai dengan penelitian yang dilakukan oleh Del Greco et al (1969) mencatat bahwa, pada pasien PGK stadium V yang menjalani HD mengalami perubahan pada hemodinamik jantung salah satunya kinetik ventrikel kiri. Hal serupa juga dinyatakan oleh Mehta et al (1983) bahwa pemindahan toksin uremik dan stimulasi perubahan kalsium dan kalium dapat meningkatkan fungsi jantung.…”

Section: Pembahasanunclassified

The Effect of Hemodialysis on Kinetic Segment of Left Ventricular in Stage V Chronic Kidney Diseases Patients

Kamasita

Suryono

Nurdian

et al. 2018

NLJ

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ABSTRAKPenyakit ginjal kronik (PGK) stadium V banyak menyerang organ tubuh lain seperti organ jantung yang dapat menyebabkan terjadinya penyakit kardiovaskuler (PKV). Salah satunya PKV yang diakibatkan oleh PGK stadium V yaitu penurunan kinetik segmen ventrikel kiri. Penyakit kardiovaskuler terjadi karena kelebihan cairan dan penumpukan toksin uremik. Penyakit ginjal kronik stadium V tidak bisa disembuhkan sehingga memerlukan terapi yaitu hemodialisis (HD). Hemodialisis dapat mengurangi kelebihan cairan, toksin uremik, dan menjaga keseimbangan elektrolit pada PGK stadium V. Cairan yang membaik dan toksin uremik yang menurun dapat mengurangi beban jantung dan regangan sehingga pasokan darah ke area miokard tertentu meningkat dan kinetik segmen ventrikel kiri meningkat. Tujuan penelitian ini yaitu untuk mengetahui pengaruh HD terhadap perubahan kinetik segmen ventrikel kiri pada pasien PGK stadium V di RSD dr. Soebandi Jember. Desain penelitian yang digunakan adalah quasi-experimental one group pretest-postest design. Sampel penelitian berjumlah 30 pasien. Responden ditentukan dengan teknik nonprobability sampling dengan metode purposive sampling. Data yang digunakan yaitu data primer dan data sekunder. Analisis data menggunakan uji Wilcoxon. Berdasarkan hasil penelitian diperoleh distribusi sampel berdasarkan usia terbanyak pada rentang 45-54 tahun, berdasarkan jenis kelamin diperoleh perempuan lebih banyak, berdasarkan lama hemodialisis diperoleh jangka waktu terbanyak hemodialisis >24 bulan dan berdasarkan tekanan darah sebelum dan sesudah hemodialisis diperoleh pasien terbanyak mengalami hipertensi. Uji hipotesis menggunakan uji Wilcoxon didapatakan p-value = 0,000. Dari hasil analisis tersebut bisa diambil kesimpulan yaitu terdapat pengaruh hemodialisis terhadap kinetik segmen ventrikel kiri pada pasien PGK stadium V di RSD dr Soebandi Jember. ABSTRACT Chronic kidney disease (CKD) stage V attacks other organs such as heart that can cause cardiovascular disease (CVD

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Hemodynamic Studies in Chronic Uremia

Cited by 88 publications

References 24 publications

Blood Pressure Response to Uncomplicated Hemodialysis: The Importance of Changes in Stroke Volume

Blood Pressure Response to Uncomplicated Hemodialysis: The Importance of Changes in Stroke Volume

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

The Effect of Hemodialysis on Kinetic Segment of Left Ventricular in Stage V Chronic Kidney Diseases Patients

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