Hypotension and Ultrafiltration Physiology in Dialysis

Leunissen, Karel M.L.; Kooman, Jeroen P.; Sande, Frank M. van der; Kuijk, Willi H M van

doi:10.1159/000014444

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…Evidence of venous pooling or impaired venous tone in hemodialysis-induced hypotension in the presence of blood volume reduction has already been reported [8,36]. Dialysis patients with diastolic dysfunction due to high sensitivity to cardiac filling pressure particularly suffer from impaired venous capacity control [37].…”

Section: Discussionmentioning

confidence: 99%

Model-based study of the effects of the hemodialysis technique on the compensatory response to hypovolemia

Cavalcanti¹,

Ciandrini²,

Severi³

et al. 2004

Kidney International

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Section: Discussionmentioning

confidence: 99%

Model-based study of the effects of the hemodialysis technique on the compensatory response to hypovolemia

Cavalcanti¹,

Ciandrini²,

Severi³

et al. 2004

Kidney International

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“…Intradialytic hypotension (IDH) is one of the most important and frequent short-term complications of hemodialysis (HD) treatment, its incidence being about 20% of all treatments. 1 Although some controversy exists over the pathophysiology of IDH, 2,3 there is general agreement that central blood volume (CBV) depletion, through impairment of cardiac filling in the diastole leading to a cardiac output (CO) reduction, is of major importance. The fact that some patients are particularly hypotension prone (HP) whereas most are rarely affected might be due to differences in the capability of maintaining an adequate CBV during ultrafiltration.…”

Section: Introductionmentioning

confidence: 99%

Central venous oxygen saturation and thoracic admittance during dialysis: New approaches to hemodynamic monitoring

Cordtz

Olde

Solem

et al. 2008

Hemodialysis International

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Intradialytic hypotension (IDH) is one of the most important short-term complications to hemodialysis (HD). Inadequate cardiac filling due to a reduction in the central blood volume is believed to be a major etiological factor. The aim of this study was to evaluate whether these pathophysiologic events are reflected in the central venous oxygen saturation (ScO(2)) and thoracic admittance (TA) during dialysis. Twenty ambulatory HD patients, 11 hypotension prone (HP) and 9 hypotension resistant, with central vascular access, were monitored during 3 HD sessions each. ScO(2), TA, finger blood pressure (BP), and relative change in blood volume (DeltaBV) were measured and sampled continuously. The relative TA decrease and DeltaBV were both largest in the HP group (p<0.05 for both), whereas ScO(2) decreased only in HP patients (p<0.001). Baseline TA was lower in the HP group (p<0.01). Changes in ScO(2) and TA correlated much closer than did changes in ScO(2) and DeltaBV (r=0.43 and 0.18, respectively). Our results suggest that an intradialytic decrease in cardiac output, as reflected by a fall in ScO(2), is a common feature to HD patients prone to IDH. In patients using a central vascular access, ScO(2) and TA measurements may be more specific to the pathophysiologic events preceding IDH than DeltaBV-the current standard monitoring method.

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“…Arterial hypotension still represents a major complication resulting from HD therapy; it frequently shortens the duration of dialysis and increases patient mortality rates (4)(5) . The pathogenesis of hemodynamic instability in response to fluid removal probably involves many factors such as defective plasma refilling (6) , abnormal body heating (7)(8) , an imbalance between endothelin and nitric oxide synthesis (9) , and defective adjustment of arteriovenous tone in response to the changes in the effective plasma volume (10) . An abrupt hypovolemia should induce a sympathetic activation that increases the heart rate and total peripheral resistance (10) .…”

Section: Introductionmentioning

confidence: 99%

Intraocular pressure and ocular perfusion during hemodialysis

Barbosa¹,

Stefanini²,

Penha³

et al. 2011

Arq. Bras. Oftalmol.

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RESUMO Descritores: Diálise renal; Insuficiência renal crônica; Pressão intraocular; Glaucoma ABSTRACTAim: To evaluate the intraocular pressure and ocular perfusion pressure during a hemodialysis. Methods: Sixty-seven eyes from thirty-five patients were evaluated at the beggining of hemodialysis, 2 hours and 4 hours after initiation. Intraocular pressure was evaluated using a Tonopen. Systolic and diastolic arterial pressures were measured with a manual sphygmomanometer. The ocular perfusion pressure was estimated by measuring the difference between 2/3 of the mean arterial pressure and the intraocular pressure values. Generalized estimating equations were used to evaluate the difference between the repeated measurements using the appropriate correction for inter-eye dependency. Results: There was no statistically significant difference in ocular perfusion pressure, in intraocular pressure (p=0.93) and in systolic arterial pressure (p=0.92) at the three time points (p=0.69). But, when analyzing the extreme values, some patients exhibited lower diastolic perfusion pressures at all time points. Conclusion: Our results did not support the view that significant changes in ocular perfusion pressure and intraocular pressure occur during hemodialysis session. However, we observed that some patients exhibited lower diastolic perfusion pressures, which could be a poor prognostic factor for glaucoma patients.

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Hypotension and Ultrafiltration Physiology in Dialysis

Cited by 10 publications

References 27 publications

Model-based study of the effects of the hemodialysis technique on the compensatory response to hypovolemia

Model-based study of the effects of the hemodialysis technique on the compensatory response to hypovolemia

Central venous oxygen saturation and thoracic admittance during dialysis: New approaches to hemodynamic monitoring

Intraocular pressure and ocular perfusion during hemodialysis

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