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Hemodynamics in hemofiltration.

C A Baldamus, W Ernst, M J Lysaght

    The International Journal of Artificial Organs
    |January 1, 1983
    PubMed
    Summary
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    Hemofiltration maintains blood pressure and vascular stability better than hemodialysis by preserving physiological responses to fluid removal. This vascular stability is not due to sodium retention.

    Area of Science:

    • Nephrology
    • Cardiovascular Physiology

    Background:

    • Intratreatment vascular stability is improved during hemofiltration, but the underlying mechanisms are not fully understood.
    • Hemodialysis can lead to hemodynamic instability.

    Purpose of the Study:

    • To investigate the phenomenon of improved intratreatment vascular stability during hemofiltration compared to hemodialysis.
    • To elucidate the physiological mechanisms responsible for enhanced vascular stability during hemofiltration.

    Main Methods:

    • A comparative study involving 10 stable hemodialysis patients undergoing both matched hemodialysis and hemofiltration treatments.
    • Measurements included mean arterial blood pressure, total peripheral vascular resistance, plasma noradrenaline concentration, and sodium loss.
    • Treatments were matched for fluid withdrawal rate, small molecule removal, and dialysate/replacement fluid composition.

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    Main Results:

    • Mean arterial blood pressure was maintained during hemofiltration, with increases in total peripheral vascular resistance and plasma noradrenaline.
    • Hemodialysis resulted in a significant fall in mean arterial blood pressure, with unchanged peripheral resistance and noradrenaline levels.
    • Sodium loss was comparable between both treatment modalities.

    Conclusions:

    • Improved hemodynamic stability during hemofiltration is attributed to a preserved physiological response to ultrafiltration, which is impaired during hemodialysis.
    • Vascular stability in hemofiltration is not a result of sodium retention compared to hemodialysis.