The purpose of this study was to evaluate in chronic hemodialysis patients the hemodynamic modifications of the low and the high pressure systems induced by fluid removal during hemodialysis and related procedures. In the low pressure system, fluid removal leads to pressure decrements and a significant relationship exists between fluid removal expressed in percent of initial body weight and pulmonary arterial pressure or pulmonary wedge pressure. The slope of the pressure/weight loss curve can be influenced by the hormonal status of the patient, the Na concentration of dialysate and slightly the nature of the buffer salt in the dialysate. The high pressure system seems mainly influenced by dialysis modalities. Whereas acetate dialysis decreases systemic vascular resistances and increases cardiac index and stroke index, bicarbonate dialysis acts in the opposite way. A significant correlation exists between stroke index and plasma Na acetate level (p < 0.01) and between systemic vascular resistances and plasma Na acetate level (p < 0.001). A decrease of blood pressure in hypertensive patients is more regularly obtained during hemofiltration than during hemodialysis. Hypertension becomes volume dependent with hemofiltration treatment. It is of interest to have these volume-depletion-related and treatment-modalities-related hemodynamic modifications in mind to prevent and correct symptomatic hemodynamic disturbances in chronic hemodialysis patients.

Keywords:
Chronic renal failure, Cardiac catheterization, Dialysis procedures, Fluid removal, Hemodynamics
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© 1983 S. Karger AG, Basel
1983
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