Document Detail


Effects of hypervolemia on interdialytic hemodynamics and blood pressure control in hemodialysis patients.
MedLine Citation:
PMID:  9328359     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The influence of hypervolemia on hemodynamics and interdialytic blood pressure, as well as in relation to vascular compliance, was investigated in 10 hemodialysis patients who were not receiving vasoactive medication. All subjects were studied during a relative normovolemic interdialytic period (from 1 kg below dry weight postdialytic until dry weight predialytic) and a hypervolemic interdialytic period (from 1 kg above dry weight postdialytic until 3 kg above dry weight predialytic). Interdialytic blood pressure was measured with an ambulatory blood pressure monitor. Cardiac output was echographically measured and total peripheral resistance calculated postdialytic, mid-interdialytic, and predialytic. At the same time, a blood sample was drawn for analyzing vasoactive hormones, sodium, and hematocrit. In all patients, ideal dry weight was estimated by echography of the caval vein. Arterial and venous compliance were measured with an ultrasound vessel wall movement detector system and a strain-gauge plethysmograph. After fluid load, an increase in intravascular volume, an increase in caval vein diameter and cardiac output, and a decrease in peripheral resistance was observed. No significant influence of a 3-L fluid load was found on interdialytic blood pressure course (153+/-24 mm Hg/90+/-19 mm Hg in the hypervolemic period and 146+/-27 mm Hg/89+/-22 mm Hg in the normovolemic period). Sodium and osmolality were similar in the hypervolemic and normovolemic interdialytic periods. After fluid load, a decrease in arginine vasopressin and angiotensin II was observed, which probably contributed to the decreased systemic vascular resistance. Catecholamines were not influenced by fluid load, but increased during the interdialytic period, suggesting accumulation after dialysis. Three of the 10 patients had higher systolic but not diastolic blood pressures after fluid load (159+/-13 mm Hg/81+/-22 mm Hg in the hypervolemic period and 135+/-16 mm Hg/81+/-22 mm Hg in the normovolemic period). No correlation could be found between arterial or venous compliance and blood pressure changes. We concluded that a 3-L interdialytic fluid load does not result in higher blood pressure in most hemodialysis patients.
Authors:
A J Luik; W H van Kuijk; J Spek; F de Heer; L M van Bortel; P M Schiffers; J P van Hooff; K M Leunissen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  30     ISSN:  0272-6386     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-10-23     Completed Date:  1997-10-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  466-74     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, St Maartens Gasthuis, Venlo, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure / physiology
Blood Volume / physiology*
Body Weight
Case-Control Studies
Female
Hemodynamics / physiology*
Humans
Hypertension, Renal / physiopathology*
Kidney Failure, Chronic / physiopathology*,  therapy*
Male
Middle Aged
Prospective Studies
Renal Dialysis*
Water-Electrolyte Imbalance / etiology,  physiopathology
Comments/Corrections
Comment In:
Am J Kidney Dis. 1997 Oct;30(4):577-8   [PMID:  9328376 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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