Hemodynamic study of hypotension during hemodialysis

Kinét, Jean-Pierre; Soyeur, D; Balland, N; Saint-Remy, Michel; Collignon, P; Godon, J. P.

doi:10.1038/ki.1982.111

Cited by 97 publications

(49 citation statements)

References 19 publications

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“…Odar-Cederloef et al [17]observed falls of neck vein pressure by about 1.2 mm Hg and rises in circulating norepinephrine by 30% during isolated ultrafiltration with fluid removal of about 2.1 liters. Kinet et al [18]reported reduction of mean pulmonary capillary wedge pressure by 9.4 mm Hg after hemodialysis, whereas tilting-induced reductions of central venous pressure of about 3.4 mm Hg produced significant elevations of circulating ET-1 [19]. …”

Section: Discussionmentioning

confidence: 99%

Effect of a Hemodialysis Session on Plasma Levels of Endothelin-1 in Hypertensive and Normotensive Subjects with End-Stage Renal Failure

Surdacki

Sułowicz

Wieczorek-Surdacka

et al. 1999

Nephron

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Background: Elevated plasma endothelin-1 (ET-1) was found in end-stage renal failure (ESRF). However, there are discordant reports on the influence of hypertension on plasma ET-1 in ESRF and on the effect of hemodialysis on ET-1 concentrations. Aim: To compare the time course of plasma ET-1 during hemodialysis in hypertensive (HT) and normotensive (NT) ESRF patients. Methods: Plasma ET-1 and mean blood pressure (MP) were measured in 12 HT patients and 11 matched NT patients on maintenance hemodialysis at baseline (B), after a 2.5–3.5 h hemodialysis with ultrafiltration (P1) and after a subsequent 1 h isovolumic dialysis (P2). Results: In HT patients, plasma ET-1 increased at P1 with no further change after P2 (B vs. P1 and P2, p < 0.05). In NT patients, ET-1 levels were similar at B, P1 and P2. In HT, but not in NT subjects, volume loss correlated with change of ET-1 at P1. In HT patients, MP fell during P1 and tended to return towards baseline at P2. In NT patients, MP dropped after P1 and remained lower also at P2. Conclusion: Hypertensive ESRF subjects exhibit potentiated ET-1 release on hemodialysis, possibly stimulated by volume depletion with sympathetic activation, which may attenuate hypotensive hemodialysis effects thus contributing to hypertension in ESRF.

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Section: Discussionmentioning

confidence: 99%

Effect of a Hemodialysis Session on Plasma Levels of Endothelin-1 in Hypertensive and Normotensive Subjects with End-Stage Renal Failure

Surdacki

Sułowicz

Wieczorek-Surdacka

et al. 1999

Nephron

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“…2,8 Modern dialysis delivery systems such as the Centrysystem 3 provide precise volumetric ultrafiltration control, which accurately regulates and measures the volume of fluid removed by ultrafiltration for enhanced hemodynamic stability. Separate proportioning of the sodium and buffer concentrates allows use of bicarbonate rather than acetate in the dialysate.…”

Section: Discussionmentioning

confidence: 99%

Applications and Outcome of Hemodialysis in Cats: A Review of 29 Cases

Langston

Cowgill

Spano

1997

Veterinary Internal Medicne

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Hemodialysis (HD) has been used in the management of renal failure in dogs, but its feasibility has not been reported for uremic cats. Therefore, we investigated the technical possibility, efficacy, and complications of intermittent HD in cats with severe uremia. A total of 160 HD treatments were performed on 29 cats with acute renal failure (ARF) (n = 15). chronic renal failure (CRF) (n = 6), or acute on CRF (n = 8) between November 1993 and June 1996. Hemodialysis treatments were performed with transcutaneous dialysis catheters using a bicarbonate-based delivery system, sodium modeling, and volumetric-controlled ultrafiltration. Presenting serum chemistries (mean i SD) for all cats were creatinine, 16.4 i-7.5 mg/dL; blood urea nitrogen (BUN), 229 t 87 mg/dL; phosphate, 15.4 t 5.4 mg/dL; potassium, 6.0 t 1.6 mEq/L; and HCO; , 16.0 t 4.4 mEq/L. For intensive HD treatments, pre-HD versus post-HD creatinine changed from 10.3 i 4.4 t o 1.6 2 0.9 rng/dL and BUN from 105 i 33 t o 8 he therapeutic alternatives for acute renal failure (ARF) T or advanced chronic renal failure (CRF) in cats are limited.' Many cats with ARF remain unresponsive to attempts to promote diuresis or die as a result of the metabolic disturbances of uremia before repair of renal damage can occur. Therapy itself may contribute to life-threatening complications that cannot be resolved (eg, overhydration). For cats with end-stage CRF, dietary and conventional medical therapy often is poorly accepted or ineffective, resulting in poor quality of life and owner frustration. Hernodialysis (HD) is the most common form of renal replacement therapy for the majority of human patients with severe uremia. With HD, an artificial kidney alleviates azotemia and life-threatening acid-base, electrolyte, and metabolic disturbances of renal failure by removal of toxic solutes and excessive fluid from the body. The procedure requires reusable access to the vasculature, an effective extracorporeal flow of blood, an artificial kidney (heniodialyzer), and a delivery system to facilitate generation of dialysate and transfer of uremic solutes. Hemodialysis has been successfully employed in dogs with ARF and CRF, but the small size of cats has posed technical hurdles with vascular access, blood delivery, extracorporeal circulation, and hemodynamic stability that precluded its application in this species. The volume of pediatric blood lines and dialyzers suitable for use in dogs approximated the total blood volume of cats. Fluid removal by ultrafiltration was difficult to regulate and monitor accurately on older delivery systems and frequently induced hypovolemia and hypotension. Acetate-based dialysate formulations caused vasodilation and hemodynamic instability with the rapid delivery of acetate to dogs.' The combination of these technical factors led to predictable decreases in blood pressure in experimental and pet dogs treated with HD despite their larger size and made dialysis unsuitable for cats.' Technologic developments and sophistication of dialysis delivery tec...

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“…Chronic hypervolemia leads to hypertension, structural heart disease, and pulmonary edema (1)(2)(3)(4)(5)(6), and intradialytic hypovolemia is associated with cramps, nausea, vomiting, and decreased patient satisfaction (7)(8)(9)(10)(11). Intradialytic hypotension is one of the most frequent complications of hemodialysis (HD); its incidence varies from 10 to 30% of sessions, depending on the population studied (12).…”

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confidence: 99%

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Brennan

Ronan

Goonewardena

et al. 2006

Clinical Journal of the American Society of Nephrology

190

133

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Accurate intravascular volume assessment is critical in the treatment of patients who receive chronic hemodialysis (HD) therapy. Clinically assessed dry weight is a poor surrogate of intravascular volume; however, ultrasound assessment of the inferior vena cava (IVC) is an effective tool for volume management. This study sought to determine the feasibility of using operators with limited ultrasound experience to assess IVC dimensions using hand-carried ultrasounds (HCU) in the outpatient clinical setting. The IVC was assessed in 89 consecutive patients at two outpatient clinics before and after HD. Intradialytic IVC was recorded during episodes of hypotension, chest pain, or cramping. High-quality IVC images were obtained in 79 of 89 patients. Despite that 89% of patients presented at or above dry weight, 39% of these patients were hypovolemic by HCU. Of the 75% of patients who left HD at or below goal weight, 10% were still hypervolemic by HCU standards. Hypovolemic patients had more episodes of chest pain and cramping (33 versus 14%, P ‫؍‬ 0.06) and more episodes of hypotension (22 versus 3%, P ‫؍‬ 0.02). The clinic with a higher prevalence of predialysis hypovolemia had significantly more intradialytic adverse events (58 versus 27%; P ‫؍‬ 0.01). HCU measurement of the IVC is a feasible option for rapid assessment of intravascular volume status in an outpatient dialysis setting by operators with limited formal training in echocardiography. There is a poor relationship between dry weight goals and IVC collapsibility. Practice variation in the maintenance of volume status is correlated with significant differences in intradialysis adverse events.

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Hemodynamic study of hypotension during hemodialysis

Cited by 97 publications

References 19 publications

Effect of a Hemodialysis Session on Plasma Levels of Endothelin-1 in Hypertensive and Normotensive Subjects with End-Stage Renal Failure

Effect of a Hemodialysis Session on Plasma Levels of Endothelin-1 in Hypertensive and Normotensive Subjects with End-Stage Renal Failure

Applications and Outcome of Hemodialysis in Cats: A Review of 29 Cases

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

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