Document Detail

Mathematical investigation of some physiological factors involved in hemodialysis hypotension.
MedLine Citation:
PMID:  9247178     Owner:  NLM     Status:  MEDLINE    
A previously developed mathematical model is used to investigate the role of some hemodynamic, regulatory, and osmotic factors in the development of symptomatic hypotension during hemodialysis. Sensitivity analysis of the model parameters suggests that a decrease in atrial pressure, with a consequent fall in cardiac output (Frank-Starling mechanism), is the primary hemodynamic perturbation induced by ultrafiltration. Also, during the first hours of a hemodialysis session, the sympathetic mechanism working on systemic resistance is the main factor responsible for arterial pressure maintenance, and the physiological response is probably characterized by a prevalence of the cardiopulmonary over the arterial baroreflex control. During this period, a decrease in plasma osmolarity, caused mainly by urea removal, may contribute to the reduction of vascular refilling. During the last hours of the session, the arterial pressure level is also significantly affected by other factors that influence vascular refilling and mean circulatory filling pressure (systemic compliance; action of feedback mechanisms working on venous unstressed volume; plasma oncotic pressure; and, especially, capillary wall permeability and interstitial space elastance). Simulation of hemodialysis with different modalities emphasizes the importance of avoiding high ultrafiltration rates and of maintaining the sodium concentration in the dialysate close to the sodium concentration of the extracellular fluid to limit the risk of symptomatic hypotension. Higher values of sodium in the dialysate are, however, associated with poor sodium removal from the extracellular pool with risks of interdialytic morbidity. In the future, the model may be used to optimize the ultrafiltration rate and sodium profile in the dialysate according to individual patient prescriptions.
M Ursino; M Innocenti
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Artificial organs     Volume:  21     ISSN:  0160-564X     ISO Abbreviation:  Artif Organs     Publication Date:  1997 Aug 
Date Detail:
Created Date:  1997-12-01     Completed Date:  1997-12-01     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  7802778     Medline TA:  Artif Organs     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  891-902     Citation Subset:  IM    
Department of Electronics, Computer Science and Systems, University of Bologna, Italy.
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MeSH Terms
Baroreflex / physiology
Blood Pressure / physiology
Blood Proteins / metabolism
Blood Volume
Capillary Permeability / physiology
Cardiac Output / physiology
Cardiovascular Physiological Phenomena
Computer Simulation*
Extracellular Space / physiology
Hypotension / etiology,  physiopathology*
Models, Biological*
Renal Dialysis / adverse effects*,  standards
Sodium / metabolism
Urea / blood
Vascular Resistance / physiology
Water-Electrolyte Balance
Reg. No./Substance:
0/Blood Proteins; 57-13-6/Urea; 7440-23-5/Sodium

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

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