Hemodialysis-AssociatedHypoxemia

Garella, Serafino; Chang, Bruce S.

doi:10.1159/000166825

Cited by 28 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Those with diabetes demonstrated a significantly higher median relative blood flow at 6 mm tissue depth [25 vs. 14 arbitrary units (AU) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14); P = 0.048] at baseline compared with the non-diabetic group (Table 1).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

et al. 2009

View full text Add to dashboard Cite

Aims To examine the cutaneous microcirculation on the dorsum of the foot before, during and after haemodialysis in diabetic and non-diabetic patients. MethodsFourteen age-matched patients (seven diabetic, seven non-diabetic) without active foot ulceration were studied. Cutaneous microcirculation was assessed using a micro-lightguide spectrophotometer to measure venous oxygen saturation and relative blood flow determined at two tissue depths: 2 and 6 mm. Cumulative relative changes of each parameter during haemodialysis were calculated as area under the curve. Differences between and within the groups were calculated by Mann-Whitney U -test and ANOVA following post hoc testing, respectively.Results At baseline, relative blood flow at 6 mm tissue depth was significantly greater in diabetic patients ( P = 0.048). Thirty minutes after the end of dialysis, relative blood flow at 2 and 6 mm tissue depth was significantly higher in nondiabetic patients ( P = 0.048 and P = 0.001). Mean cumulative relative changes in venous oxygen saturation and relative blood flow at 2 mm as well as 6 mm tissue depth were positive for non-diabetic subjects and negative for diabetic patients. ConclusionsHaemodialysis is associated with changes in cutaneous microcirculation, which differ between people with and without diabetes. In those without diabetes, we found an increase in blood flow during haemodialysis, whereas blood flow was reduced in diabetic patients. This may be the result of abnormal vasomotor regulation due to distal neuropathy. Diabet. Med. 26, 89-92 (2009)

show abstract

Section: Resultsmentioning

confidence: 99%

“…It has been suggested that the increase in incidence of new foot ulcers may be in part the result of haemodialysis itself [2]. It has been known for many years that haemodialysis is associated with generalized hypoxaemia [4][5][6][7], but the cause is not clear.…”

Section: Introductionmentioning

confidence: 99%

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Hypoxemia during hemodialysis (HD) is a welldescribed phenomenon [1][2][3][4][5]. Although several mechanisms have been proposed [6], the cause remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Gas Exchange During Hemodialysis: A Comparison of Subjects With and Without COPD on Bicarbonate Hemodialysis

Alfakir

Moammar

Chaudry

et al. 2010

Chest

View full text Add to dashboard Cite

Little is known about the effect of hemodialysis (HD) on gas exchange in subjects with chronic obstructive pulmonary disease (COPD). The purpose of this study was to examine blood gases and pH in COPD patients undergoing HD with bicarbonate dialysate. We studied thirteen subjects with COPD and thirteen controls (CON). All were dialyzed for 4 hrs against a bicarbonate HD solution. Blood gases, pH and HCO 3 were initially analyzed (t 0) and, during HD, at 30 min (t 0.5), 1 hr (t 1) and 4 hrs (t 4). At t 0 , a statistically significant difference was observed for PO 2 (CON: 84.7±3.60, COPD: 72.19±4.92; p<0.001). For the first hr, PO 2 decreased, and at t 1 , oxygen was required for 6 COPD subjects. By t 4 , there was no significant difference in PO 2 between groups. The alveolar-arterial gradient (ΔA-a) remained different between groups (P<0.001, all times), with increasing ΔA-a for both groups up to t 1 and decreasing over the remaining 3 hr. For both groups, at t 4 , ΔA-a was higher than at t 0 (p<0.001). For PCO 2 , both groups demonstrated increases from t 0 to t 1 (p=0.0004), with COPD having PCO 2 higher than CON at t 0.5 and t 1 (p<0.05 for both); by t 4 , PCO 2 levels decreased to nearly the same as at t 0. Over the 4 hr treatment, HCO 3 and pH increased significantly for both groups; however no significant difference was observed between COPD and CON. Markedly increased ΔA-a is observed during HD in some COPD patients. COPD patients retain more CO 2. However, the effect of HCO 3 leads to mild metabolic alkalosis at t 4 .

show abstract

“…A ventilation/perfusion abnormality caused by pulmonary vascular leukostasis has also been suggested [6]. However, although pulmonary vascular leukostasis occurs [14], it now appears that this phenomenon is not causally linked with hypoxemia [2,11] and the role of this component, if indeed it has one, would appear to be small [4,15,16]. Supporting evidence for changes in pulmonary circulation are the decrease in carbon monoxide diffu sion during dialysis [1,17] and a decrease in pulmonary capillary blood flow after dialysis [18].…”

Section: Discussionmentioning

confidence: 99%

Hypoxemia during Hemodialysis in Patients with Impairment in Pulmonary Function

Serrano¹,

Vega²,

Grande³

1986

Nephron

View full text Add to dashboard Cite

In order to examine the effect of different dialysates on hemodialysis-induced hypoxemia, 6 stable patients with chronic pulmonary disease (CPD) were compared with 8 control subjets using, alternately, acetate and bicarbonate in the dialysate. These patients were also studied during acetate dialysis and 2 liters/min of nasally administered oxygen. In the control group the presence of hypoxemia with acetate and its absence with bicarbonate suggests that the major mechanism responsible for hypoxemia is hypoventilation. In CPD patients the higher hypoxemia with acetate which bicarbonate analysis did not prevent suggests that a superimposed mechanism may be an important factor in hypoxia aggravation. In these patients hypoxemia can be prevented easily by increasing the inspired oxygen concentration.

show abstract

Hemodialysis-AssociatedHypoxemia

Cited by 28 publications

References 19 publications

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

Haemodialysis is associated with changes in cutaneous microcirculation in diabetes mellitus

Pulmonary Gas Exchange During Hemodialysis: A Comparison of Subjects With and Without COPD on Bicarbonate Hemodialysis

Hypoxemia during Hemodialysis in Patients with Impairment in Pulmonary Function

Contact Info

Product

Resources

About