Hemodynamic changes during hemodialysis, sequential ultrafiltration, and hemofiltration.
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I Resa
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Recirculation dialysis (RD) (20 to 40 liters of dialysate) with venous bicarbonate buffering - an alternative procedure to hemofiltration (HF).
We report about a dialysis procedure, the circulation stability of which is comparable to hemofiltration treatment. Hemodynamic parameters were measured invasively and different procedures were compared for each patient. In RD and HF significant reduction in cardiac output (HF: --20%, RD: --21.5%), stroke volume (HF: --20%, RD: --17%), pulmonary artery pressure (HF: --57%, RD: --45:6%) and plasma volume (HF: --12%, RD: --15%) were found. Blood pressure and heart rate (HF: --1%, RD: --3%) remained stable despite the high utrafiltration rate. Peripheral resistance rose significantly (HF: + 20%, RD: + 25.9%). Compared with HG, the most important advantage during RD is the improved tolerance to treatment without typical hemodialysis-induced symptoms. In comparison to that, we found under conventional dialysis an inadequate increase in peripheral resistance (HD: + 6.1%). A following strong compensatory hyperventilation with drop in PCO2 was paralleled with typical symptoms like nausea and headache. Because of resttriction of this compensatory mechanism, hypotension and arrhythmia will be induced of the following peripheral tissue perfusion and central acidosis.
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