Document Detail


Hypotension during hemodialysis results from an impairment of arteriolar tone and left ventricular function.
MedLine Citation:
PMID:  15847254     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Hypotensive episodes are a major complication of hemodialysis. Hypotension during dialysis could be directly related to a reduction in blood volume or to a decrease in cardiovascular activation as a response to decreased cardiac filling. A decreased cardiovascular activation could be due to patient-related or to dialysis-related factors. In order to study the isolated effect of a reduction in filling pressure, lower body negative pressure (LBNP) causes activation of the cardiovascular reactivity with a decrease in cardiac filling, but without the influence of the dialysis procedure that could affect cardiovascular reactivity. METHODS: We studied the relationship between relative blood volume (RBV), central venous pressure (CVP), systolic arterial pressure, heart rate, stroke volume index (SI), and total peripheral resistance index (TPRI) during a combined dialysis/ultrafiltration and during LBNP to -40 mmHg in 21 hemodialysis patients with a high incidence of hypotension. Systolic arterial pressure, heart rate, SI and TPRI were measured by Finapres. CVP was measured after cannulation of the jugular vein. During dialysis RBV was measured by a blood volume monitor (BVM). In order to study the conditions in which hypotension occurred after dialysis, we divided the patients into 2 groups: hypotensive (H) and non-hypotensive (NH) during dialysis. RESULTS: Baseline levels did not show any significant differences. During dialysis systolic arterial pressure declined gradually in the H group from 30 minutes before the onset of hypotension. There was a similar decrease of RBV and increase of heart rate in both groups with a large interindividual variation. At hypotension, H patients showed a significantly smaller increase in TPRI as compared to NH patients. The reduction in SI tended to be greater at hypotension, while CVP decreased to a similar extent in both groups. Moreover, during LBNP, a similar reduction in CVP resulted in a much smaller decrease in SI. Systolic arterial pressure was only slightly lowered due to a much greater increase in TPRI. CONCLUSION: We conclude that dialysis-related hypotension in our patient group did not result from an inability to maintain blood volume or from decreased cardiac filling. Hypotension appeared to result from the inability to adequately increase arteriolar tone and a reduction in left ventricular function. Both vascular tone and left ventricular function appeared to be impaired by the dialysis procedure.
Authors:
R W Nette; M A van den Dorpel; H P Krepel; E H Y Ie; A H van den Meiracker; D Poldermans; W Weimar; R Zietse
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical nephrology     Volume:  63     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-25     Completed Date:  2005-08-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  276-83     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. rwnette@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Arterioles / physiopathology
Blood Pressure / physiology
Blood Volume / physiology
Central Venous Pressure / physiology
Female
Follow-Up Studies
Humans
Hypotension / epidemiology,  etiology*,  physiopathology
Incidence
Lower Body Negative Pressure
Male
Middle Aged
Muscle, Smooth, Vascular / physiopathology*
Renal Dialysis / adverse effects*
Risk Factors
Stroke Volume / physiology
Vascular Resistance / physiology*
Ventricular Dysfunction, Left / complications,  physiopathology*

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


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