Document Detail

Vascular reactivity during combined ultrafiltration-hemodialysis: influence of dialysate-derived contaminants.
MedLine Citation:
PMID:  8989746     Owner:  NLM     Status:  MEDLINE    
It has been suggested that hemodynamic instability and impaired vascular reactivity during combined ultrafiltration-hemodialysis are related to bioincompatibility factors such as dialysate-derived contaminants or the dialyzer. The study presented here investigated whether vascular reactivity could be improved by the use of sterile dialysate. Forearm vascular resistance and venous tone (measured by strain-gauge plethysmography) as well as arterial blood pressure (by Dinamap) and heart rate (by electrocardiogram) were measured in ten stable dialysis patients (age range, 28 to 71 yr) during 2 h of combined ultrafiltration-hemodialysis (bicarbonate; ultrafiltration rate 1.0 L/h). In addition, a dialysate sample was obtained for culture and limulus amebocyte lysate testing while blood was withdrawn for the estimation of plasma bactericidal/permeability increasing factor (measured by ELISA) and the soluble tumor necrosis factor receptor p75 (measured by ELISA). Patients served as their own control, comparing dialysis with nonsterile and sterile dialysate. No bacterial growth was observed in sterile dialysate, whereas all samples were positive for Pseudomonas in culture in nonsterile dialysis. All limulus amebocyte lysate tests were negative. Bactericidal/permeability increasing factor tended to increase during nonsterile dialysis (P = 0.063) and remained unchanged during sterile dialysis. In both treatments, tumor necrosis factor receptor p75 increased significantly (P < 0.01). There were no significant differences in hemodynamic parameters between the treatment modalities. Despite use of sterile dialysate, forearm vascular resistance remained unchanged whereas venous tone decreased significantly. These results indicate that vascular reactivity during combined ultrafiltration-hemodialysis is not improved by the use of sterile dialysate.
W H van Kuijk; W A Buurman; P G Gerlag; K M Leunissen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  7     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-04-01     Completed Date:  1997-04-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2664-9     Citation Subset:  IM    
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
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MeSH Terms
Antigens, CD / blood
Antimicrobial Cationic Peptides
Blood Bactericidal Activity
Blood Pressure
Blood Proteins / metabolism
Cytokines / physiology
Dialysis Solutions / adverse effects*
Drug Contamination
Heart Rate
Hemodiafiltration / adverse effects*
Membrane Proteins*
Middle Aged
Pseudomonas / isolation & purification
Receptors, Tumor Necrosis Factor / blood
Receptors, Tumor Necrosis Factor, Type II
Vascular Resistance
Reg. No./Substance:
0/Antigens, CD; 0/Antimicrobial Cationic Peptides; 0/Blood Proteins; 0/Cytokines; 0/Dialysis Solutions; 0/Membrane Proteins; 0/Receptors, Tumor Necrosis Factor; 0/Receptors, Tumor Necrosis Factor, Type II; 0/bactericidal permeability increasing protein

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