Effect of dialysate composition on intercompartmental fluid shift

Fleming, Simon J.; Wilkinson, James S.; Greenwood, Roger; Aldridge, C.; Baker, L. R. I.; Cattell, W. R.

doi:10.1038/ki.1987.202

Cited by 31 publications

(15 citation statements)

References 10 publications

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“…As we find an increase in blood volume, the decrease in osmolarity by decreased plasma urea concentrations does not result in a volume shift towards the intracellular compartment. These findings are in accordance with those of Fleming et al [14], who previously observed that changes in blood volume are not correlated with urea efflux. However, in this study there was a positive correlation between changes in blood volume and the extracellular sodium concentration.…”

Section: Discussionsupporting

confidence: 83%

“…This could explain why these previous studies failed to observe significant differences. Fleming et al [14] studied blood volume changes during diffusive dialysis, and found no significant change in blood volume. However, in this study only 12 sessions with standard sodium concentrations were studied, and only 1 or 2 (17 in total) blood volume measurements were done, while in our experiment RBV was measured continuously during 60 sessions.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid these problems, the effect of blood volume can best be studied during dialysis without net ultrafiltration (diffusive dialysis). The effect of diffusive dialysis on changes in blood volume has only been reported by Fleming et al [14]. However, this study was set up to investigate the effect of different dialysate sodium concentrations on blood volume, rather than the effect of diffusive dialysis on blood volume.…”

Section: Introductionmentioning

confidence: 99%

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Increase in Blood Volume during Dialysis without Ultrafiltration

Nette

Akcahuseyin²,

Krepel³

et al. 2000

Blood Purif

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Combined dialysis and ultrafiltration leads to more frequent episodes of hypotension than isolated ultrafiltration. It has been suggested that decreased plasma volume preservation could be responsible for this phenomenon. The present study evaluates the effects of diffusive dialysis on the changes in relative blood volume (RBV). Six stable hemodialysis patients, without the need of ultrafiltration, were studied during 10 sessions of diffusive dialysis (bicarbonate) lasting 4 h. RBV was monitored continuously by measurement of hematocrit. During the 1st and 2nd h RBV increased by 2.4 ± 1.4 and 2.5 ± 0.8% respectively, returning to baseline levels at the end of dialysis. No changes in blood pressure or heart rate were noted. We conclude that during diffusive dialysis without ultrafiltration RBV is increased. A decrease in vascular resistance, or changes in regional blood distribution could explain these findings.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Increase in Blood Volume during Dialysis without Ultrafiltration

Nette

Akcahuseyin²,

Krepel³

et al. 2000

Blood Purif

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“…To minimize the effect of blood volume reduction as one of the contributing factors, it is extremely important to carefully observe the distribution of fluids and sodium [3, 4, 5, 6, 7, 8, 9]. The sodium dialysate concentration has often been increased so as to obtain intradialytic cardiovascular stability [10].…”

Section: Introductionmentioning

confidence: 99%

Sodium and Fluid Modulation in Dialysis: New Approach

Splendiani

Costanzi²,

Passalacqua³

et al. 2001

Nephron

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Hypotension during hemodialysis is still an unsolved problem. The treatment of patients with cardiovascular instability is efficaciously carried out with the use of ‘profiled dialysis’ (PD) with computerized modulation of ultrafiltration and conductivity. We tested a new profile model which involves progressive decrease of ultrafiltration associated with variable conductivity (‘bell pattern’). We observed 8 stable long-term patients receiving hemodialysis (4 men and 4 women, mean age 63.5 years) for 4 h three times a week. Before our test, sodium balance had reached a steady state in all patients and remained stable during the entire observation period. The sodium balance was established by means of a simple pattern suggested by Ursino and coworkers. The patients were observed for two periods of 1 month each (protocols A and B). The intradialytic mean arterial pressure was studied, checking every hour of dialysis. Statistical analysis was done by ANOVA for repeated measures. We compared standard dialysis with constant ultrafiltration rate and conductivity (protocol A) with sessions performed involving a progressive decrease of ultrafiltration together with a variable conductivity of –0.2, +0.2, +0.6, +0.6, 0, –0.4, –0.4, and –0.4 mS/s (protocol B). We found a lower incidence of hypotension (p < 0.01) with better cardiovascular stability during and after treatment in ‘profiled dialysis’.

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“…To our knowledge, only two reports exist regarding BV changes during diffusive dialysis (dialysis without ultrafiltration). Fleming et al [3] studied the effect of dialysate composition on intercompartmental fluid shift changes during 1.5 or 2 h of HD without net ultrafiltration using high, normal and low sodium dialysate. They concluded that dialysate composition affects the movement of water into and out of the plasma and erythrocytes in a manner that can be explained by altered plasma concentrations of osmotically active substances.…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin Changes at the Initiation of High-Flux Hemodialysis

Sombolos

Christidou²,

Bamichas³

et al. 2006

Nephron Clin Pract

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Background: The aim of the present study was to assess hemoglobin changes occurring at the beginning of high-flux hemodialysis (HD). Methods: In a group of 20 chronic HD patients (group A), total hemoglobin (tHb), hematocrit (Hct) and total serum proteins (TP) were measured in blood samples drawn from an arterial fistula needle before the initiation of high-flux HD, and from an arterial line 5 min after HD with the dialysate in the bypass mode. 31 chronic stable HD patients (group B) served as controls. In group B patients, tHb was measured in blood samples drawn from an arterial fistula needle before the initiation of high-flux HD, and from arterial and venous lines simultaneously 5 min later. Blood flow rates in groups A and B were set from the beginning of the study to 300 ml/min, while the bicarbonate dialysate flow rate and ultrafiltration rate in group B patients was set to 700 ml/min and zero, respectively. The same high-flux dialyzer was used for all patients (FLX-18, membrane PEPA 1.8 m²). Results: A comparison of baseline (pre-dialysis) values with those derived from an analysis of the arterial line in groups A and B at 5 min revealed that tHb decreased by 0.6 ± 0.2 g/dl (5.2 ± 1.7%, p < 0.001) and 0.7 ± 0.7 g/dl (5.4 ± 6.2%, p < 0.001), respectively. At the same time, Hct and TP in group A decreased by 1.32 ± 0.7% (3.8 ± 2.0%, p <0.001) and 0.3 ± 0.1 g/dl (4.8 ± 1.4%, p < 0.001), respectively. Blood volume (BV) and plasma volume (PV) in group A patients at 5 min as calculated from tHb and TP values increased by 5.6 ± 1.9 and 5.2 ± 1.7%, respectively, while BV in group B patients increased by 6.1 ± 7.0% (not significant when compared to group A). tHb did not change significantly in 14 patients (group C) studied immediately after adopting the supine position and 5 min later in the absence of HD. Conclusion: A 5% decrease in tHb was observed 5 min after the initiation of high-flux HD with a zero ultrafiltration rate, and was due to an increase in BV.

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Effect of dialysate composition on intercompartmental fluid shift

Cited by 31 publications

References 10 publications

Increase in Blood Volume during Dialysis without Ultrafiltration

Increase in Blood Volume during Dialysis without Ultrafiltration

Sodium and Fluid Modulation in Dialysis: New Approach

Hemoglobin Changes at the Initiation of High-Flux Hemodialysis

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