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Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this measurement...
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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Published on: October 2, 2020

Hemodynamic and volume changes during hemodialysis.

Robert M Lindsay1, Tanya Shulman, Suma Prakash

  • 1Optimal Dialysis Research Unit, London Health Sciences Center and The University of Western Ontario, London, Ontario, Canada. Robert.Lindsay@lhsc.on.ca

Hemodialysis International. International Symposium on Home Hemodialysis
|April 22, 2009
PubMed
Summary
This summary is machine-generated.

Fluid removal during hemodialysis (HD) reduces extracellular fluid (ECF) and blood volume (BV), but blood pressure (BP) is maintained by increasing peripheral vascular resistance (PVR). Leg ECF reduction may cause cramps.

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A Murine Model of Hemodialysis Access-Related Hand Dysfunction
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Published on: May 31, 2022

Area of Science:

  • Nephrology
  • Cardiovascular Physiology
  • Fluid Balance

Background:

  • Volume overload is a key factor in hemodialysis (HD) patient hypertension.
  • Fluid removal via ultrafiltration (UF) is crucial but can cause intradialytic hypotension and cramps.
  • Understanding hemodynamic and fluid compartment changes during UF is essential to mitigate adverse effects.

Purpose of the Study:

  • To quantify changes in body fluid compartments during UF.
  • To determine relationships between blood pressure (BP), blood volume (DeltaBV), central blood volume (CBV), cardiac output (CO), peripheral vascular resistance (PVR), and fluid volumes (TBW, ICF, ECF).
  • To elucidate mechanisms underlying BP regulation and adverse effects during HD UF.

Main Methods:

  • Indicator dilution technology (Transonic) for CBV, CO, and PVR.
  • Hematocrit monitoring (Crit-Line) for DeltaBV.
  • Segmental bioimpedance (Xitron) for total body water (TBW), intracellular fluid (ICF), and extracellular fluid (ECF).

Main Results:

  • UF causing a -7% DeltaBV led to minor changes in CBV and CO, with preferential refilling of CBV post-cessation.
  • Predialysis HD patients exhibit ECF expansion (ECF/ICF ratio = 0.96 vs. 0.74 in controls).
  • UF-induced ECF reduction correlated with decreased BP and increased PVR; CBV and CO were maintained. ECF reduction was greatest from the legs.

Conclusions:

  • Predialysis ECF status significantly influences BP during HD.
  • UF effectively reduces DeltaBV and ECF, with PVR increases compensating to conserve CBV and BP.
  • ECF reduction primarily occurs in the legs, potentially explaining cramps; intradialytic hypotension arises from impaired PVR response.