Influence of Dialysate and Membrane Biocompatibility on Hemodynamic Stability in Hemodialysis

Abstract

The contributions of membrane biocompatibility, dialysate temperature and sodium concentration to hemodynamic stability during hemodialysis were studied in 8 patients with a high incidence of hemodialysis-induced symptomatic hypotension. Patients were treated during 8 different periods, randomly ordered in each case, resulting from the combination of the following: the membrane, either Cuprophan or Polyacrylonitrile; the dialysate temperature, 37 or 35 degrees C, and the sodium concentration, 133 or 139 mmol/l. The incidence of symptomatic hypotension was lower at 35 degrees C in the entire study with either membrane and either sodium concentration. It was also lower with a sodium concentration of 139 mmol/l with either temperature and either membrane. There was a lower incidence of symptomatic hypotension when using Polyacrylonitrile, but this difference was not significant. We conclude that changes in physicochemical parameters of dialysate lead to worth-while improvement of symptomatic hypotension in hemodialysis patients, but membrane biocompatibility seems to play a minor role.

Hemodialysis with Low-Temperature Dialysate: A Long-Term Experience

“…Our results confirm the beneficial effects of cool dialysate on intradialysis symptoms, as previously found in a short-term study [18]. The reduction in percentage of symptomatic H D and in prevalence of SH was similar in both studies and this improvement remained uniform throughout the long-term follow-up.…”

“…It mainly affects females and aged individuals (1,2], It has a multifactorial origin [3][4][5] and although different therapeutic procedures have been tried -bicarbonate dialysis, high sodium dialysate, se quential ultrafiltration HD, hemofiltration and oxygen administration during HD [6][7][8][9][10][11][12] it has not yet been elimi nated. Amelioration of this problem has been recently described, with the use of low-temperature (34.5-35 °C) dialysate [13][14][15][16][17], We observed similar results in a double blind study performed in a group of patients with a high incidence of SH [18]. Nevertheless, these findings need to be confirmed in long-term studies, thus allowing us to establish the permanency of this effect and its possible complications.…”

Beneficial Effect of Cold Dialysate for the Prevention of Hemodialysis-lnduced Hypoxia

“…In the studies by Maggiorc et al [7,8] a lowering of the dialysate temperature from 35.3 to 24.9 °C also resulted in a less pronounced decrease in oxygen tension. In two other stud ies no difference in the response regarding PaO: was found when the dialysate tempera tures 35.0 and 37.0°C were compared [9,10], In all these studies acetate was used as the dial ysate buffer, and to our knowledge the present investigation is the first where the effect of dialysate temperature on oxygenation during bicarbonate HD has been evaluated.…”

Systemic Cardiovascular Response in Hemodialysis without and with Ultrafiltration with Membranes of High and Low Biocompatibility

“…10]. Whether membrane biocompatibility also influences hemodynamics during hemo dialysis has not been settled [1][2][3][11][12], Previous studies indicate that membranes with low biocompatibilitv are associated with elevated pulmonary vascular resistance [7] and may induce hemodynamic instability in critically ill patients [13] whereas stable he modialysis patients seem to be less influenced [7,14,15]. However, the hemodynamic in fluence of bioincompatibility during hemodi alysis may be confounded by the concomitant circulatory responses to volume depletion (i.e.…”