Raymond Hakim
Last active: 6/9/2014

Cardiovascular instability during hemodialysis.

Lazarus JM, Henderson LW, Kjellstrand CM, Weiner MW, Henrich WL, Hakim RM
Trans Am Soc Artif Intern Organs. 1982 28: 656-65

PMID: 7164319

The major point of contention in the discussions following the formal panel presentation, both among members of the panel and the audience, was the role of sodium and its proper control while evaluating the effect of hemofiltration, sequential dialysis, and/or bicarbonate dialysis on cardiovascular instability. It appears that studies, carefully controlling the level of dialysate sodium, have not been performed, or reported in the literature. Hemodiafiltration, sequential dialysis, increased sodium dialysate and bicarbonate dialysate all seem to reduce the incidence and intensity of hypotension; however, the mechanisms have not yet been elucidated. Complications from these changes, particularly increased sodium must be considered. Methods of evaluation of underlying cardiac disease, autonomic neuropathy and hormonal changes were suggested. Use of equipment with newer membrane material, alterations of dialysis technique, were agreed as likely methods to combat the incidence and severity of cardiovascular instability. It is apparent from the discussion that there remain a number of areas to be investigated in evaluating the causes of hemodialysis-induced hypotension. Controlled studies, dissecting out each of the above noted factors, will be important in determining their relative importance in modification of future therapy.

MeSH Terms (13)

Acetates Autonomic Nervous System Diseases Bicarbonates Biocompatible Materials Blood Flow Velocity Blood Volume Cardiovascular System Humans Hypotension Osmolar Concentration Renal Dialysis Sodium Ultrafiltration

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