Hemodynamic changes induced by regular hemodialysis and sequential ultrafiltration hemodialysis: A comparative study

Area of Science:

• Nephrology
• Cardiovascular Physiology

Background:

• Hemodialysis patients often experience fluid overload.
• Managing fluid balance during dialysis is crucial for hemodynamic stability.

Purpose of the Study:

• To compare the hemodynamic effects of regular hemodialysis (RD) with sequential ultrafiltration hemodialysis (SUH).
• To investigate the impact of ultrafiltration and diffusion on cardiovascular parameters.

Main Methods:

• Ten maintenance dialysis patients underwent both RD and SUH sessions.
• Hemodynamic parameters were monitored using a thermistor Swan-Ganz catheter.
• A mean ultrafiltration of 2000 ml was applied in both procedures.

Main Results:

• Ultrafiltration alone caused significant decreases in cardiac index, stroke index, and pulmonary wedge pressure.
• During SUH diffusion, total vascular resistance decreased, leading to hypotension in seven patients.
• RD with simultaneous ultrafiltration and diffusion resulted in stable vascular resistance but severe hypotensive episodes.

Conclusions:

• Dialysis diffusion may induce arterial vasodilation, impairing hemodynamic adaptation to hypovolemia.
• SUH is effective for fluid removal in overhydrated patients under medical supervision.
• SUH should not routinely replace RD due to potential hemodynamic instability.