PMID- 19379366
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20091229
LR  - 20090421
IS  - 1492-7535 (Print)
IS  - 1492-7535 (Linking)
VI  - 7
IP  - 3
DP  - 2003 Jun 1
TI  - Hemodynamic and volume changes during hemodialysis.
PG  - 204-8
LID - 10.1046/j.1492-7535.2003.00041.x [doi]
AB  - BACKGROUND: Volume overload is a factor in the hypertension of hemodialysis (HD) 
      patients. Fluid removal is therefore integral to the hemodialysis treatment. 
      Fluid removal by hemodialysis ultrafiltration (UF) may cause intradialytic 
      hypotension and leg cramps. Understanding blood pressure (BP) and volume changes 
      during UF may eliminate intradialytic hypotension and cramps. Studies (S1, S2, 
      and S3) were carried out to determine the amount and direction of changes in body 
      fluid compartments following UF and to determine the relationships between BP, 
      changes in blood volume (DeltaBV), central blood volume (CBV), cardiac output 
      (CO), peripheral vascular resistance (PVR) plus total body water (TBW), and 
      intra- and extracellular fluid volumes (ICF, ECF) in both the whole body and body 
      segments (arms, legs, trunk). METHODS: Indicator dilution technology (Transonic) 
      was used for CBV, CO, and PVR; hematocrit monitoring (Crit-Line) was used for 
      DeltaBV segmental bioimpedance (Xitron) for TBW, ICF, and ECF. RESULTS: S1 (n = 
      21) showed UF sufficient to cause DeltaBV of -7% and lead to minor changes (same 
      direction) in CBV and CO, and with cessation of UF, vascular refilling was 
      preferential to CBV. S2 (n = 20) showed that predialysis HD patients are 
      ECF-expanded (ECF/ICF ratio = 0.96, controls = 0.74 [P < 0.0001]) and BP 
      correlates with ECF (r = 0.47, P = 0.35). UF to cause DeltaBV of -7% was 
      associated with a decrease in ECF (P < 0.0001) and BP directly (r = 0.46, P = 
      0.04) plus DeltaBV indirectly (r = -0.5, P = 0.024) correlated with PVR, while 
      CBV and CO were maintained. S3 (n = 11) showed that following UF, total-body ECF 
      changes were correlated with leg ECF (r = 0.94) and arm ECF (r = 0.72) but not 
      trunk ECF. Absolute ECF reduction was greatest from the legs. CONCLUSIONS: 
      Predialysis ECF influences BP and UF reduces DeltaBV and ECF, but CBV and BP are 
      conserved by increasing PVR. ECF reduction is mainly from the legs, hence may 
      cause cramps. Intradialytic hypotension is caused by failure of PVR response.
FAU - Lindsay, Robert M
AU  - Lindsay RM
AD  - Optimal Dialysis Research Unit, London Health Sciences Center and The University 
      of Western Ontario, London, Ontario, Canada. Robert.Lindsay@lhsc.on.ca
FAU - Shulman, Tanya
AU  - Shulman T
FAU - Prakash, Suma
AU  - Prakash S
FAU - Nesrallah, Gihad
AU  - Nesrallah G
FAU - Kiaii, Mercedeh
AU  - Kiaii M
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - Hemodial Int
JT  - Hemodialysis international. International Symposium on Home Hemodialysis
JID - 101093910
EDAT- 2003/06/01 00:00
MHDA- 2003/06/01 00:01
CRDT- 2009/04/22 09:00
PHST- 2009/04/22 09:00 [entrez]
PHST- 2003/06/01 00:00 [pubmed]
PHST- 2003/06/01 00:01 [medline]
AID - HDI041 [pii]
AID - 10.1046/j.1492-7535.2003.00041.x [doi]
PST - ppublish
SO  - Hemodial Int. 2003 Jun 1;7(3):204-8. doi: 10.1046/j.1492-7535.2003.00041.x.