Monitoring cardiovascular changes during hemodialysis in children

Abstract

Hemodialysis (HD) causes rapid volume shifts and circulatory changes. In chronic renal failure (CRF) Na+/K+ATP-ase is depressed, whereas endogenous digoxin-like factor (EDLF) is elevated. Our aim was to characterize HD-induced cardiovascular adaptation and its possible links to Na+/K+ATP-ase and EDLF. Eleven children with CRF on HD (aged 14.7 +/- 3.7 years) and 11 healthy children were investigated for basic circulatory parameters. Thoracic impedance (Zo) and circulatory parameters were monitored by impedance cardiography (ICG) during HD. Erythrocyte Na+/K+ATP-ase and EDLF were measured before and after HD. Up to the loss of 6% of total body weight, Zo rose linearly with fluid removal, above this no further increase occurred. Heart rate and mean arterial pressure (MAP) were inversely related (r = -0.97); MAP rose in the first and decreased in the second part of HD. Systemic vascular resistance paralleled MAP, whereas stroke volume rapidly decreased, but stabilized in the second part of HD. The ratio of preejection period/ventricular ejection time (PEP/VET) correlated positively with HD duration (r = 0.92), suggesting diminished cardiac filling. Cardiac index (CI) remained stable. EDLF was high in uremia accompanied by depressed Na+/K+ATP-ase (P < 0.05 and P < 0.01, respectively). Following HD Na+/K+ATP-ase normalized. Correlation between Na+/K+ATP-ase activity and MAP was linear (r = 0.85). In conclusion, ICG during HD provides detailed information concerning circulatory adaptation resulting in stable CI, suggesting that the dialysis-induced hypovolemia is compensated by the centralization of the blood volume. Changes of Na+/K+ATP-ase indicate that dialyzable blood pressure-regulating substance(s) inhibit(s) the pump. However, lack of further correlation between Na+/K+ATP-ase, EDLF, and cardiovascular parameters indicates the complexity of the regulatory processes.

Utility of Impedance Cardiography for the Detection of Hemodynamic Changes in Stable Patients With Sickle Cell Disease

“…[17][18][19][20] Use of ICG to monitor hemodynamic changes during laparoscopy and hemodialysis in children has also demonstrated that ICG can track the hemodynamic changes accurately during the procedure. 9,10 In our validation study of 12 children, we have shown that ICG monitoring of CO correlates well with the CO measured by the TD technique in children. 21 Potential limitations in the use of ICG are conditions in which the HR is greater than 250 beats/min, severe aortic valve regurgitation, an extremely high BP (mean arterial pressure >130 mm Hg) and in patients whose circulation is supported by an intra-aortic balloon pump.…”

“…[4][5][6][7][8] There are reports of ICG use in children to monitor hemodynamic changes during surgical procedures and hemodialysis. 9,10 However, the use of ICG to evaluate the effects of erythrocytapheresis on hemodynamic changes in children with sickle cell disease (SCD) has not been reported.…”

Cerebral hemodynamics among non-diabetic hemodialysis patients

“…The present study demonstrated a decrease in MFV of MCA and PCA by 32% and 28%, respectively, in nondialysis day among non-diabetic ESRD on regular HD, which may carry high risk of increase prevalence of cerebrovascular stroke among HD patients Previous studies observed cerebral blood flow changes during hemodialysis session that may be contributed to many intra-dialytic cycle factors as rapid volume ultrafiltration, transient hypotension, changes in electrolytes, and cerebral water content or arterial hypoxemia that may induce possible subtle brain damage [1,6,7]. Thus, the worst time to communicate with dialysis patients may be during the hemodialysis sessions [8].…”

Endothelin-1 Antagonist in the Management of Refractory Systemic Hypertension in Children with End Stage Kidney Disease: A Case Series

“…Evidence of uremic arteriopathy has also been demonstrated in children with ESKD [34] [35]. However, large volume ultra-filtration during hemodialysis in a short period of time, results in diminished cardiac filling, and decreased tolerance for dialysis [36]. Therefore, there are wide fluctuations in BP in children with ESKD on hemodialysis, making it difficult to define acceptable limits.…”