[Hemodynamic disorders and their correction in peritoneal dialysis of children with acute renal failure]

Hemodynamic disorders occurring during acute renal failure (ARF) in children with the hemolytic uremic syndrome and the effects of peritoneal dialysis on hemodynamics were studied. A complex of electrophysiological methods was used: Integral whole body rheography, electrocardiography, and polycardiography, which permitted assessment of the severity and type of hemodynamic disorders in ARF. Three main types of hemodynamic changes were observed: hypodynamic, hyperdynamic, and normodynamic. The circulation regimen depended on the manifestation of extracardiac (hypovolemia, increase of the total peripheral resistance) and/or cardiac factors (reduction of the cardiac pump and contractile functions as a result of myo- or pericarditis, metabolic disorders in the myocardium). Specification of the hemodynamic diagnosis permitted a purposeful correction of the hemodynamic disorders (sympathomimetic amines, cardiac glycosides, vasodilators, infusion therapy). Peritoneal dialysis had an unfavorable effect on the hemodynamics of patients with impaired pump function of the myocardium and of those with hypovolemia, deteriorating at the same time the tolerance to volumic loading. Dopamine infusion reduced the hemodynamic disorders both "on an empty abdomen" and after filling of the abdominal cavity. Goal-oriented correction of the hemodynamics helped reduce the circulatory disorders during all stages of treatment of ARF.