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Related Experiment Videos

Interstitial correction of blood volume decrease during hemodialysis.

P M Kouw1, P M De Vries, P L Oe

  • 1Division of Hemodialysis, Free University Hospital, Amsterdam, The Netherlands.

The International Journal of Artificial Organs
|October 1, 1989
PubMed
Summary
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Hypotension during hemodialysis is complex. Reduced blood volume from ultrafiltration and acetate contribute, while refilling capacity is crucial for maintaining blood pressure.

Area of Science:

  • Nephrology
  • Physiology

Background:

  • Hypotension is a common complication during hemodialysis.
  • Fluid shifts and acetate in dialysate are implicated in its etiology.

Purpose of the Study:

  • To investigate the effects of ultrafiltration on blood volume, blood pressure, and fluid refilling during hemodialysis.
  • To clarify the roles of acetate and blood volume decrease in hemodialysis-induced hypotension.

Main Methods:

  • Calculated intra- and extracellular fluid changes.
  • Assessed blood volume, blood pressure, and refilling capacity in relation to ultrafiltration and acetate levels.

Main Results:

  • Blood volume decrease was directly dependent on ultrafiltration rates.
  • High ultrafiltration rates led to refilling failure, exacerbated by high plasma acetate levels.

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  • Isolated blood volume decrease did not cause hypotension; high acetate levels were necessary.
  • Refilling fluid primarily originated from the extracellular compartment; intracellular shifts occurred only with high dialysate sodium.

    • Conclusions:

    • Both ultrafiltration-induced blood volume decrease and acetate contribute to hypotension during hemodialysis.
    • Acetate appears to reduce compensatory refilling capacity.
    • Fluid refilling predominantly occurs from the extracellular space.