Impact of High Blood Flows on Vascular Stability in Haemodialysis

Ronco, Claudio; Feriani, M; Chiaramonte, S; Conz, P; Brendolan, Alessandra; Bragantini, L; Milan, Massimo; Fabris, A; Dell'Aquila, R; Dissegna, D.; Crepaldi, Carlo; Agazia, B; Finocchi, G; Dominicas, E. De; Greca, G. La

doi:10.1093/ndt/5.suppl_1.109

Cited by 50 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Short dialysis is associated with high-speed ultrafiltration and rapid removal of small molecules, thus swiftly depleting plasma volume. In a study by Ronco et al [44] ultrafiltration rates of 0.3, 0.4, 0.5, and 0.6 ml/min/kg were associated with approximate rates for IDH of 8, 15, 26, and 60%, respectively. In addition to an increased mortality with rapid ultrafiltration, a recent DOPPS [4] also showed markedly higher odds of IDH episodes in patients with an ultrafiltration rate of 1 10 ml/h/kg.…”

Section: Intradialytic Hypotension and Duration Of Dialysismentioning

confidence: 92%

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Twardowski

2006

Blood Purif

View full text Add to dashboard Cite

Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Over the next three decades, dialysis duration was shorten to 4, 3, even 2 h in thrice weekly schedules. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that the time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/V_urea) equals 0.95–1.0. This number was later increased to 1.3, but the assumption that hemodialysis time is of minimal importance remained unchanged. However, Kt/V_urea measures only the removal of low molecular weight substances and does not consider the removal of larger molecules. Nor does it correlate with the other important function of hemodialysis, namely ultrafiltration. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control leading to left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Kt/V_urea should be abandoned as a measure of dialysis quality. The formula suggests that it is possible to decrease t as long as K is proportionately increased, but this is not true. Time of dialysis should be adjusted in such a way that patients would not suffer from symptoms related to rapid ultrafiltration, would not have other uremic symptoms and most patients would have blood pressure controlled without antihypertensive drugs.

show abstract

Section: Intradialytic Hypotension and Duration Of Dialysismentioning

confidence: 92%

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Twardowski

2006

Blood Purif

View full text Add to dashboard Cite

show abstract

“…up to 1,600 ml/min. In a series of ESRD patients on chronic hemodialysis studied with Doppler measurement we found an average blood (low in the fistulas of 864 ml/min [6]. Furthermore, we found that the blood flow in the fistula was not affected by the activation of the extracorporeal circulation.…”

mentioning

confidence: 56%

Central Circulation, Peripheral Circulation and Recirculation

Ronco

Bellomo

1997

Blood Purif

View full text Add to dashboard Cite

“…However, correcting fluid excess both in perito-DOI: 10.1159/000494582 neal dialysis and HD by providing a low salt diet is a risk for the RRF/UO [45,46]. The hazards of ultrafiltration rate are now well described, associated with increased risk of intradialytic hypotensive episodes [47] and circulatory stress including the kidneys [48], but mechanisms and thresholds, if any, remain to be examined more deeply [49,50]. Moreover, the hazards of the initial dehydration in incident dialysis patients have not been evaluated.…”

Section: Fluid Status the Permanent Dilemma With Preservation Of Rrfmentioning

confidence: 99%

End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

Chazot

Jean

2018

Blood Purif

View full text Add to dashboard Cite

Recently the concept that prescription of chronic hemodialysis (HD) start should be tailored based on residual renal function (RRF) and urine output (UO) has been revived from the past and called infrequent or incremental dialysis. It mainly consists in prescribing 1 or 2 HD sessions per week instead of what has become the standard thrice-weekly HD. It is both surprising and fascinating that almost 60 years after the first end-stage kidney disease patient was treated by Scribner et al. [Trans Am Soc Artif Intern Organs 1960; 6: 114–122], the nephrology community still questions the best way to start HD therapy. This comforting process is the result of pieces of evidence accumulated with time such as that RRF is associated with better outcomes that starting HD therapy favors the loss of RRF and/or UO and also results in a high rate of deaths in the first weeks of HD therapy. Through this review, we support the idea that when the decision to start HD therapy is made, ideally with the full collaboration of the patient, it is necessary to be efficient to alleviate uremic symptoms, to correct the fluid overload and to allow a full recovery from the uremic state associated with the late stages of non-dialysis chronic kidney disease.

show abstract

Impact of High Blood Flows on Vascular Stability in Haemodialysis

Cited by 50 publications

References 0 publications

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Treatment Time and Ultrafiltration Rate Are More Important in Dialysis Prescription than Small Molecule Clearance

Central Circulation, Peripheral Circulation and Recirculation

End-Stage Kidney Patients Require Hemodialysis Therapy Full Start

Contact Info

Product

Resources

About