Document Detail

Paradoxical rise in blood pressure during ultrafiltration is caused by increased cardiac output.
MedLine Citation:
PMID:  11936425     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In some haemodialysis patients, blood pressure increases during the dialysis session despite ultrafiltration (UF). METHODS: We investigated six such patients who were not responsive to hypotensive drugs. Their echocardiograms were obtained prior to and during the dialysis session. RESULTS: After the mean 2520 +/- 1698 (4.5 +/- 2.3% of BW) ml of fluid was removed, the cardiac systolic function parameters significantly improved and maximum mean arterial pressure rose (from 107 +/- 5 to 118 +/- 6 mmHg, p < 0.027). This increase in blood pressure was accompanied by an increase in cardiac index (from 3.8 +/- 0.6 to 4.8 +/- 1.1 L/min/m2, p < 0.027). With continuing UF, after a mean fluid removal of 4133 +/- 1622 (7.5 +/- 2.1% of BW) ml, normal blood pressure was achieved in all patients. Previously increased ejection fraction and fractional shortening decreased. End-diastolic volume significantly decreased from 98 +/- 34 to 78 +/- 35 ml/m2 indicating normovolemia. This decrease in blood pressure was accompanied by a return of cardiac index to normal values (from 4.8 +/- 1.1 to 3.1 +/- 0.8 L/min/m2, p < 0.027). There was a positive correlation between mean arterial pressure and cardiac index (r = 0.56, p = 0.017). CONCLUSION: We hypothesize that our patients had passed the top of the Frank-Starling curve and were on the descending limb at the initial examination. With UF, patients first shifted to the left and upward on the curve. With further UF, they came down the ascending limb of the curve. In conclusion, paradoxical blood pressure rise during UF is caused by increased cardiac output, mediated by volume overload and can be treated by intensified UF.
Ali Ihsan Gũnal; Ilgin Karaca; Hüseyin Celiker; Erdoğan Ilkay; Soner Duman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nephrology     Volume:  15     ISSN:  1121-8428     ISO Abbreviation:  J. Nephrol.     Publication Date:    2002 Jan-Feb
Date Detail:
Created Date:  2002-04-08     Completed Date:  2002-11-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  42-7     Citation Subset:  IM    
Department of Nephrology, Firat University Medical School, Elazig, Turkey.
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MeSH Terms
Blood Pressure / physiology*
Cardiomyopathies / etiology,  physiopathology*
Hemodiafiltration / adverse effects*
Hypertension / etiology*,  physiopathology
Middle Aged
Stroke Volume / physiology*

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