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

Abstract

In order to test whether dialyzer membrane biocompatibility influences systemic cardiovascular function, we treated 8 hemodialysis patients (4 men and 4 women, aged 24-73 years) with a low-biocompatible (cuprophane) and a high-biocompatible (polyacrylonitrile) membrane in a randomized double-blind crossover protocol using bicarbonate hemodialysis without ultrafiltration for the first 60 min and with ultrafiltration for the remaining treatment time. Left ventricular function and systemic hemodynamics were assessed noninvasively at baseline and during treatment by Doppler echocardiography combined with external subclavian artery pulse trace calibrated with oscillometrically measured brachial artery blood pressures. There was no significant difference in the cardiovascular response to the 2 membranes, neither during isolated hemodialysis nor when ultrafiltration was added. Mean arterial pressure increased 10% (p < 0.001) during isolated hemodialysis and returned to baseline levels with ultrafiltration. The cardiac index decreased 22 % (p < 0.001) during ultrafiltration, due to the greater decrease in left ventricular stroke index (30%, p < 0.001) than increase in heart rate (9%, p < 0.05). Total peripheral resistance increased 10% (p < 0.05) during isolated hemodialysis and a further 19% (p < 0.01) when ultrafiltration was added. Hence, profound cardiovascular alterations were observed during hemodialysis treatment; however, these changes were not related to the biocompatibility of the membranes.

Effectiveness and efficiency of methods of dialysis therapy for end-stage renal disease: systematic reviews.

“…Cellulose membrane Aakhus, 1995Bergamo, 1991Collins, 1993Danielson, 1986Locatelli, 1996Quereda, 1988Skroeder, 1994…”

“…In 16 of these, the method of random allocation used was not described. A secure method of random allocation concealment prior to final trial entry (third party or computer randomisation) was used in three trials (Aakhus et al, 1995;Grooteman et al, 1995;Locatelli et al, 1996); three others (Bergamo Collaboration, 1991;Parker et al, 1996) had potentially insecure methods of random allocation concealment (coin toss with no stated third party involvement and alternation).…”

“…In three trials, blinding was mentioned; in one (Aakhus et al, 1995), the membranes were hidden by a covering from the patient and investigator and, in another (Danielson et al, 1986), the patients and healthcare workers were blinded but the method of blinding was not given. There was no blinding in the trial by Gardinali and Our quality assessment tool assumes that the avoidance of bias is best achieved by an RCT with:…”

“…Data are available for seven trials that compare cellulose with synthetic membranes for this outcome measure. The number of dialysis sessions varied from eight (Aakhus et al, 1995) to 1260 (Collins et al, 1993) and this is reflected in the CIs; four trials included more than 100 dialysis sessions, and overall there is no evidence of significant heterogeneity within this group of trials. One trial (Locatelli et al, 1996) reported symptomatic hypotension, treatment-requiring and non-symptomatic hypotension, without distinguishing between these three groups; these results have not therefore been included in the meta-analysis.…”

“…The information from the 22 RCTs included in the effectiveness review showed that the same equipment and dialysate could be used for both types of membranes and the sessions, where stated, were similar in duration (see following references in the list of studies included (page 71): Aakhus et al, 1995;Bergamo Collaboration, 1991;Danielson et al, 1986;Grooteman et al, 1995;Hosokawa & Yoshida, 1991;Mrowka & Schiffl, 1993;Skroeder et al, 1993;. Therefore any difference in the cost of the dialysis is due solely to the different cost of the membrane used.…”