Continuous Computerized Monitoring of Hemodynamic Parameters during Acetate Dialysis, Bicarbonate Dialysis, and Acetate‐Free Biofiltration

Abstract

The effects of continuous, computerized, non-invasive hemodynamic monitoring on the appearance of intradialytic symptoms, aided by preventive therapeutic maneuvers, were evaluated in 30 critically ill patients undergoing regular acetate dialysis. The hemodynamic behavior was assessed by a system that interfaces a personal computer with a blood pressure monitor and to a transthoracic electrical impedance-measuring instrument. Monitoring allowed us to reduce significantly the frequency of some important intradialytic symptoms such as nausea, vomiting, and hypotension. The same monitoring system was used acutely to characterize differing hemodynamic behaviors during acetate dialysis (AD), bicarbonate dialysis (BD), and acetate-free biofiltration (AFBF). AD showed a prevalent vasodilation effect with a compensatory increase in heart rate and higher cardiac output values, which were not sufficient to maintain blood pressure stability. BD and AFBF were characterized by a more efficient vasoconstrictor effect and good hemodynamic stability. AFBF, despite a 1 h reduction in session length compared to BD, did not present significant differences in hemodynamic response resulting from session shortness or other technical changes.

Effectiveness and efficiency of methods of dialysis therapy for end-stage renal disease: systematic reviews.

“…Bologna 1989 RCT, crossover design; Five patients on haemo-Acetate vs. bicarbonate Intra-and postdialytic no description of method dialysis; sex, mean age, dialysis (vs. acetate-free symptoms not stated; (Spongano, et al, 1989)…”

Improvement of Intradialytic Hypotension in Diabetic Hemodialysis Patients Using Vitamin E‐Bonded Polysulfone Membrane Dialyzers

“…Several interventional studies on IDH include comparison of albumin concentrations, comparison of the dialysate sodium concentration (4), comparison of the dialysate calcium concentration (5), comparison of acetic acid concentration (6), and comparisons between HD and hemodiafiltration as treatment methods (7). However, few studies include any comparison of dialyzer flux or advance over conventional dialyzers.…”

Dialysis-Induced Hypotension: A Fresh Look at Pathophysiology

“…Over the last 3 years we have studied more than 80 regular HD patients for more than 300 HD sessions with a noninvasive contin uous computerized recording system of all the above-cited control hemodynamic parame ters, as previously published [12][13][14][15][16], Sys tolic, diastolic, and MBP were automatically measured every 10 min with a monitor equipped with a cuff and oscillometric sensor (Critikon, Dinamap 845. Tampa.…”