Fluid state and blood pressure control in patients treated with long and short haemodialysis
| Autor: | Karel M.L. Leunissen, Guy Laurent, A. J. Luik, J. Nisell, J.C. Divino Filho, J K Leypoldt, Jan Bergström, Krassimir Katzarski, Bernard Charra |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Blood volume Blood Pressure Vena Cava Inferior Inferior vena cava Interstitial fluid Reference Values Renal Dialysis Internal medicine Extracellular fluid medicine Electric Impedance Humans Dialysis Aged Ultrasonography Aged 80 and over Transplantation Blood Volume business.industry Middle Aged Surgery Blood pressure medicine.vein Nephrology Hypertension Cardiology Female Hemodialysis business Extracellular Space Body mass index |
| Zdroj: | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 14(2) |
| ISSN: | 0931-0509 |
| Popis: | Patients treated at the haemodialysis (HD) centre in Tassin, France have been reported to have superior survival and blood pressure (BP) control. This control has been ascribed to maintenance of an adequate fluid state, antihypertensive drugs being required in5% of the patients, although it could not be excluded that a high dose of HD regarding removal of uraemic toxins might also have been of value.The aim of the study was to assess the fluid state and BP in normotensive patients on long HD (8 h) in Tassin (group TN) using bioimpedance to measure extracellular volume (ECV), ultrasound for determining the inferior vena cava diameter (IVCD), and 'on-line' monitoring of the change in blood volume (BV), and to compare them with normotensive (group SN) and hypertensive (group SH) patients on short HD (3-5 h) at centres in Sweden. ECV was normalized (ECVn) by arbitrarily setting the median ECV (in % of body weight) in SN patients at 100% for each gender, recalculating the individual values and combining the results for male and female patients in each group.The dose of HD (Kt/V urea) was higher for TN patients than for Swedish patients who had a similar Kt/V, whether hypertensive or not. SH patients had significantly higher ECVn and IVCD than TN and SN patients. TN and SN patients did not differ significantly regarding ECVn and IVCD before and after HD. However, in a subgroup of eight TN patients, ECVn was below the range of that in SH and SN patients, due to obesity with a high body mass index. Another subgroup of 14 TN patients had a higher ECVn than most of the SN patients and also higher than the median ECVn in the SH group, without any difference in body mass index, but they were nevertheless normotensive. The fall in BV was greater in SN than in TN patients, presumably due to a higher ultrafiltration rate in SN patients. However, SH patients had a smaller change in BV than SN patients, presumably because their state of overhydration facilitated refilling of BV from the interstitial fluid.Normotension can be achieved independently of the duration and dose (Kt/V urea) of HD, if the control of post-dialysis ECV is adequate. However, this is more difficult to achieve with short than with more prolonged HD during which the ultrafiltration rate is lower, BV changes are smaller and intradialysis symptoms less frequent. The results in the subgroup of patients with high ECVn at Tassin suggest that normotension may also be achieved in patients with fluid overload provided that the dialysis time is long enough to ensure more efficient removal of one or more vasoactive factors that cause or contribute to hypertension. |
| Databáze: | OpenAIRE |
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