Influence of Computer-Modulated Profile Haemodialysis on Cardiac Arrhythmias

Ebel, H.; Saure, B.; Laage, Ch.; Dittmar, A; Keuchel, Martin; Stellwaag, M; Lange, H.

doi:10.1093/ndt/5.suppl_1.165

Cited by 15 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several groups of investigators have found the hemodialysis treatment itself to increase the rate of ventricular ectopy (103–106), although others note no such increase (107–109). Among those who have observed increased ectopy, the majority find a relationship with dialysis‐induced reductions in S K (103,110–112), although, again, this is not universally found (105). Serious dialysis‐related arrhythmias have been independently associated with underlying coronary artery disease (105,106), left ventricular hypertrophy and digoxin use (103), systolic blood pressure (109), and advanced age (105,109).…”

Section: Treatment Of Hyperkalemia In Esrdmentioning

confidence: 99%

Hyperkalemia in Dialysis Patients

Ahmed

Weisberg

2001

Seminars in Dialysis

143

View full text Add to dashboard Cite

Serious hyperkalemia is common in patients with end-stage renal disease (ESRD) and accounts for considerable morbidity and death. Mechanisms of extrarenal disposal of potassium (gastrointestinal excretion and cellular uptake) play a crucial role in the defense against hyperkalemia in this population. In this article we review extrarenal potassium homeostasis and its alteration in patients with ESRD. We pay particular attention to the factors that influence the movement of potassium across cell membranes. With that background we discuss the emergency treatment of hyperkalemia in patients with ESRD. We conclude with a review of strategies to reduce the risk of hyperkalemia in this population of patients.

show abstract

Section: Treatment Of Hyperkalemia In Esrdmentioning

confidence: 99%

Hyperkalemia in Dialysis Patients

Ahmed

Weisberg

2001

Seminars in Dialysis

143

View full text Add to dashboard Cite

show abstract

“…Headache, cramps, fatigue, nausea, arterial hypertension and cardiac arrhythmias [1,10,11] are the main compli cations seen in patients subjected to extracorporeal ace tate haemodialysis and less frequently with bicarbonate dialysis. Although the underlying mechanisms are not always quite clear, uraemic disorders of the autonomic nervous system [5], volume depletion [1,3], fluid shifts from the extra-to the intracellular space [9] and steep, transmembraneous potassium gradients [10] have been shown to account for these complications. Hence, com puter-modulated profile haemodialysis was designed to prevent these side-effects [11].…”

Section: Discussionmentioning

confidence: 99%

“…Because of the simultaneous study of cardiac arrhythmias [10], only patients with proven coronary heart disease were selected. The study had the approval of the Ethics Committee of the University of Marburg.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Profile Haemodialysis on Intra-/Extracellular Fluid Shifts and the Release of Vasoactive Hormones in Elderly Patients on Regular Dialysis Treatment

Ebel

Laage²,

Keuchel³

et al. 1997

Nephron

Self Cite

View full text Add to dashboard Cite

In 15 patients with end-stage renal failure and proven coronary heart disease, profile haemodialysis with decreasing ultrafiltration rate and hyperionic, decreasing dialysate solute concentration was compared with conventional, extracorporeal bicarbonate haemodialysis (Na⁺_D =138 mmol/l). Body fluid distribution and the release of vasoactive hormones (plasma renin activity, aldosterone, norepinephrine, epinephrine, and atrial natriuretic peptide) were investigated. Haemodialysis with constant ultrafiltration rate and constant dialysate composition (A) was followed by two dialysis profiles: decreasing ultrafiltration rate (B) and additional hyperionic, decreasing dialysate sodium concentration (C). In all 15 patients, the dialysis procedures (A) – (C) were used for 2 weeks each with six sessions, the last being taken for investigation. Body fluid distribution was calculated. In patients with serum sodium above 136 mmol/l, the conventional dialysis (A) as well as the Uf profile (B) showed a net fluid shift from extracellular volume (ECV) to intracellular volume (ICV). Using the profile with hyperionic, decreasing Na⁺D (C), the reverse fluid shift with decreasing ICV was achieved not only in those with serum Na⁺ < 136 mmol/l, but also in those with serum Na⁺ ≥ 136 mmol/l. The release of vasoactive hormones decreased already at profile haemodialysis (B) compared with (A) and was further reduced in (C). These results would suggest, profile dialyses B and C to have less impact on the cardiovascular system in elderly patients assuming higher patient comfort compared with the standard dialysis procedure. A higher benefit was obtained in C compared with B, presumably due to the additional prevention of the ICV shift and plasma volume depletion in patients with initial serum sodium ≥ 136 mmol/l using transiently hyperionic Na⁺_D. These results show that in elderly patients, hyperionic profile haemodialysis (Na⁺_D > Na⁺s) had less impact on cardiovascular regulation than conventional bicarbonate dialysis.

show abstract

“…[7,6,11,13,19]. der Plasma-Ionenkonzentrationen, des Säure-Basen-Haushalts, des volämischen Zustandes und hämodynamischer Größen.…”

unclassified

Dynamical Control of the Dialysis Process. Part l: Structural Considerations and First Mathematical Approach - Dynamische Optimierung des Dialyseprozesses. Teil 1: Grundkonzept und erster mathematischer Ansatz

Scharfetter

Bachhiesl

Kopke

et al. 1996

Bmte

View full text Add to dashboard Cite

Individual optimization of the dialysis process requires the (open-loop or closed-loop) control of many different variables, e.g. plasma ion concentrations, acid base state, volemic state and hemodynamic quantities. For this purpose a general concept for multiple-input-multiple-output (MIMO) control of the dialysis process is presented. The controlled variables have been differentiated into variables which can be modeled mechanistically (primary controlled variables, PCVs) and (hemodynamic) variables for which no mechanistic model has been developed up to now (secondary controlled variables, SCVs). Accordingly the controller is decomposed into two stages. Stage 1 contains an expert system which links the PCVs to the SCVs and provides the generation of optimal profiles for the PCVs with respect to maximum hemodynamic stability of the patient. Stage 2 is a tracking controller for the PCVs. An algorithm for the multidimensional tracking problem at stage 2 has been developed. It can be used for open-loop and future closed-loop control. The algorithm has been tested for 4 controlled (plasma Na+, plasma K+, plasma volume and ratio between intra- and extracellular volume) and 3 control variables (dialysate Na+, dialysate K+, ultrafiltration rate) up to now. It renders possible the exact tracking of the prescribed trajectories as long as all points are reachable under consideration of all physical and physiological boundary conditions. If they are not, appropriate weighting of the conflicting optimization goals must be applied. An extension towards more than 4 controlled variables is possible on principle. Main advantages of the method are its mathematical simplicity and the applicability of standard optimization subroutines.

show abstract

Influence of Computer-Modulated Profile Haemodialysis on Cardiac Arrhythmias

Cited by 15 publications

References 0 publications

Hyperkalemia in Dialysis Patients

Hyperkalemia in Dialysis Patients

Impact of Profile Haemodialysis on Intra-/Extracellular Fluid Shifts and the Release of Vasoactive Hormones in Elderly Patients on Regular Dialysis Treatment

Dynamical Control of the Dialysis Process. Part l: Structural Considerations and First Mathematical Approach - Dynamische Optimierung des Dialyseprozesses. Teil 1: Grundkonzept und erster mathematischer Ansatz

Contact Info

Product

Resources

About