Oxygen Consumption during Maintenance Hemodialysis

Blumberg, A; Keller, Guido

doi:10.1159/000181650

Cited by 33 publications

(16 citation statements)

References 17 publications

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“…However.no normal values and no methodological details were given by these authors who could not offer an explanation for the discrepancy be tween their normal 2,3-DPG concentrations and raised P50 std values nor for the lack of correlation between the two parameters. In earlier studies we demonstrated ele vated P5()s,d levels together with raised 2,3-DPG concen trations in patients on hemodialysis [5,16], and in the present investigation we were able to confirm our previ ous normal range for P50 std. We also found a correlation of 2,3-DPG with Pi (r = 0.61; p < 0.05) as has been de scribed previously in hemodialysis patients [5] and has been confirmed recently in patients on CAPD [8].…”

Section: Discussionsupporting

confidence: 86%

“…After elimination of these 2 patients the 0 2 consumption was still found to be significantly reduced in the supine position, whereas it was only bor derline low in the sitting position (0.1 > p > 0.05). It is of note that 0 2 consumption was almost identical with va lues we have previously found in hemodialysis patients, using different methods of measurements [16]. Our re sults contrast with those of Fabriset al [ 10] who described a marked elevation of minute ventilation and 0 2 con sumption approximately 50% above our values.…”

Section: Discussionsupporting

confidence: 75%

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Oxygen Affinity of Erythrocytes and Pulmonary Gas Exchange in Patients on Continuous Ambulatory Peritoneal Dialysis

Blumberg¹,

R²,

Marti³

1984

Nephron

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In 11 patients on continuous ambulatory peritoneal dialysis 2,3-diphosphoglycerate, oxygen (O₂) affinity of red cells (P₅₀), blood gases, ventilation, and O₂ consumption were studied. Contrary to patients on maintenance hemodialysis, 2,3-diphosphoglycerate and P₅₀ were normal in patients on continuous ambulatory peritoneal dialysis; they were correlated with each other. Arterial O₂ pressure was normal; under the conditions of dialysis with 35 mmol lactate per liter dialysis fluid a slight metabolic acidosis persisted; it was combined with a moderate respiratory alkalosis. Position had no influence upon pulmonary gas exchange with the exception of the alveolo-arterial gradient which was elevated when the abdominal cavity was filled with dialysis fluid and the patients assumed the supine position. Ventilation was in the normal range, whereas O₂ consumption was low, possibly due to a reduction in muscle mass in some of the patients. It is concluded that pulmonary gas exchange and erythrocyte O₂ transport were normal and that O₂ requirements tended to be low in this group of patients on continuous ambulatory peritoneal dialysis.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 75%

Oxygen Affinity of Erythrocytes and Pulmonary Gas Exchange in Patients on Continuous Ambulatory Peritoneal Dialysis

Blumberg¹,

R²,

Marti³

1984

Nephron

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“…For example, alkalyzating agents which are used in HD (acetate and bicarbonate) may affect H b-02 affinity. While several studies about the effect of acetate HD on H b-02 affinity were reported, the effect of bicarbonate H D has not been well examined [3][4][5][6][7]. Neph rogenic anemia was shown to decrease Hb-02 affinity through an elevation of red blood cell 2,3-diphosphogly cerate (2, [1,2].…”

Section: Introductionmentioning

confidence: 99%

Factors That Affect Oxygen Affinity of Hemoglobin in Chronic Hemodialysis Patients

Ando

Saitō

Takeuchi³

1987

Nephron

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To investigate various factors that possibly affect oxygen affinity of hemoglobin (Hb-O₂ affinity) in chronic hemodialysis (HD) patients, we determined P₅₀ at standard condition (P₅₀std), 2,3-diphosphoglycerate (2,3-DPG) content in red blood cells, serum inorganic phosphorus (S-Pi), Hb, and arterial blood gas analysis in 55 HD patients. P₅₀std in HD patients was higher than that in normal controls (26.6 ± 1.6 vs. 25.4 ± 1.4 mm Hg; p < 0.001). We could find neither an effect of alkalizating agents for HD (acetate vs. bicarbonate) nor an effect of the underlying disease (diabetics vs. nondiabetics) on Hb-O₂ affinity. There were significant positive correlations between P₅₀std and the duration of HD therapy (r = 0.598; p < 0.001) and between P₅₀std and SPi (r = 0.476; p < 0.001), contrasting with the absence of correlation between P₅₀std and Hb. Forward stepwise multiple-regression analysis demonstrated that the duration of HD therapy played the most important roles in determining P₅₀std, followed by SPi and PO₂. These data suggest that the major factor influencing Hb-O₂ affinity in chronic HD therapy is the duration of the therapy and that the minor factors are SPi and PO₂.

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“…A pH-induced increase in oxyhemoglobin association, however, does not appear to be important in reducing arterial oxygen tension [29],…”

Section: Resultsmentioning

confidence: 97%

“…However, the association of oxygen with deoxygenated hemoglobin is very rapid and satura tion occurs in less than 1 ms [27], It is unlikely that the increase in association constant produced by an increase in pH has any effect on pulmonary end capillary POj when the transit time for pulmonary capillary blood approximates 750 ms [28], Blurnberg and Keller [29] measured in vitro and calcu lated in vivo shifts in oxygen tension at 50% hemoglobin saturation (P5o) during acetate dialysis and noted an insignificant increase in vitro and a significant decrease in vivo of 1.06 mm Hg. Mean pH increased from 7.41 to 7.49.…”

Section: Effects O F Acid-base Changesmentioning

confidence: 99%

Determinants of Oxygenation during Hemodialysis and Related Procedures

Sherlock¹,

Ledwith²,

Letteri³

1984

Am J Nephrol

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A decrease in arterial oxygen tension during hemodialysis has been attributed to a number of factors. In order to more completely define these factors, we studied respiratory gas exchange, arterial blood gases and pH, and dialyzer flux of CO₂ during pure ultrafiltration, three types of acetate dialysis, and sorbent regenerated bicarbonate dialysis in which the dialysate concentration of bicarbonate varies. Changes due to position and extracorporeal circulation of a 300-ml volume of blood (sham dialysis) were studied for any effect contributing to the hypoxemia noted with circulation through the membrane and variation in dialysate. Alveolar oxygen tension (PAO₂) is calculated by the equation PAO₂ = PIO₂-PaCO₂ (FIO₂ + ^1-FIO2/_RE). RE is the ratio of CO₂ excretion by the lung (VCO₂) to oxygen consumption (VO₂). RE equals RQ (metabolic quotient) when no extrapulmonary CO₂ losses occur. Normals in a lounge chair had no change in RE and PACO₂. RE decreased to 0.75 during sham dialysis and PAO₂ decreased. During pure ultrafiltration RE decreased due to a decrease in VO₂ and VCO₂ with proportionately greater decrease in VCO₂. PAO₂ decreased accordingly. Acetate dialysis produced an increase in oxygen consumption without a proportional increase in CO₂ excretion and both RQ and RE decreased. When PAO₂ decreased during any of these procedures, arterial oxygen tension (PaO₂) decreased without a change in A-aO₂ gradient. No changes in PaCO₂ were noted. RQ did not change during bicarbonate dialysis. At high bicarbonate dialysate concentrations, however, PaCO₂ increased and PAO₂ decreased. The major reason for hypoxemia during acetate dialysis is a decrease in alveolar oxygen tension due to changes in metabolism and a decrease in pulmonary CO₂ excretion when CO₂ is lost from the dialyzer. The increasing pH may contribute to the metabolic change during acetate dialysis and the hypoventilation during bicarbonate dialysis. There is little evidence to support an effect of pulmonary capillary obstruction or changes in oxyhemoglobin association on the decrease in arterial oxygen tension observed.

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Oxygen Consumption during Maintenance Hemodialysis

Cited by 33 publications

References 17 publications

Oxygen Affinity of Erythrocytes and Pulmonary Gas Exchange in Patients on Continuous Ambulatory Peritoneal Dialysis

Oxygen Affinity of Erythrocytes and Pulmonary Gas Exchange in Patients on Continuous Ambulatory Peritoneal Dialysis

Factors That Affect Oxygen Affinity of Hemoglobin in Chronic Hemodialysis Patients

Determinants of Oxygenation during Hemodialysis and Related Procedures

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