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Cardiac output-changes during hemodialysis with ultrafiltration
J F Vandenbogaerde1, R C Vanholder, J A Everaert
1Department of Intensive Care, University Hospital, Ghent, Belgium.
Insights
Hemodialysis with ultrafiltration did not significantly alter overall cardiac output (CO). However, CO increased in patients with heart conditions but decreased in those without.
Area of Science:
- Cardiology
- Nephrology
- Physiology
Background:
- Cardiovascular hemodynamics are crucial in patients undergoing chronic hemodialysis.
- Ultrafiltration during hemodialysis can impact fluid balance and cardiac function.
Purpose of the Study:
- To investigate the noninvasive cardiovascular hemodynamic response to hemodialysis with ultrafiltration.
- To assess changes in cardiac output (CO) and mean blood pressure in patients on chronic hemodialysis.
Main Methods:
- Noninvasive assessment of cardiovascular hemodynamics in 18 chronic hemodialysis patients.
- Cardiac output (CO) measured using continuous wave Doppler before, during, and after hemodialysis.
- Comparison of hemodynamic responses between patients with and without manifest myocardial disease.
Main Results:
- Overall cardiac output showed no significant change post-hemodialysis (7.8 +/- 0.6 l/min vs. 7.4 +/- 0.5 l/min pre-dialysis).
- Mean blood pressure increased significantly from 103 +/- 4 mmHg to 113 +/- 3 mmHg post-hemodialysis.
- In patients with myocardial infarction or dilated cardiomyopathy (n=12), CO significantly increased (7.3 +/- 0.7 to 8.4 +/- 0.6 l/min).
- In patients without manifest myocardial disease (n=6), CO decreased (7.5 +/- 0.7 to 6.6 +/- 0.9 l/min), a significant intergroup difference (p<0.01).
Conclusions:
- Hemodialysis with ultrafiltration may increase cardiac output in patients with pre-existing heart conditions like myocardial infarction or congestive cardiomyopathy.
- Conversely, cardiac output may decrease in hemodialysis patients without manifest myocardial disease.
- Individualized hemodynamic monitoring is important during hemodialysis, especially in patients with cardiovascular comorbidities.
Abstract:
Cardiovascular hemodynamics were studied noninvasively before, during and after hemodialysis with ultrafiltration in 18 patients on chronic hemodialysis. The cardiac output (CO) was determined by a continuous wave Doppler method. Overall, no major CO changes were seen (7.8 +/- 0.6 l/min post- versus 7.4 +/- 0.5 l/min pre-dialysis). Mean blood pressure rose slightly but significantly from 103 +/- 4 mmHg before to 113 +/- 3 mmHg after hemodialysis (p less than 0.01). Important interindividual differences in the intradialytic evolution of CO were observed. In patients with previous myocardial infarction or dilated cardiomyopathy (n = 12), CO rose significantly from 7.3 +/- 0.7 l/min before to 8.4 +/- 0.6 l/min after hemodialysis (p less than 0.05), while in patients without manifest myocardial disease (n = 6) CO decreased from 7.5 +/- 0.7 l/min to 6.6 +/- 0.9 l/min (NS). Comparison of the evolution of CO in both groups by variance analysis revealed a significant difference (p less than 0.01). It is concluded that, in response to hemodialysis with ultrafiltration, CO probably will increase in patients with myocardial infarction or congestive cardiomyopathy, but probably will decrease in patients without.