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Dialysis-induced hypoxaemia

T Kishimoto1, H Tanaka, M Maekawa

  • 1Department of Urology, Osaka City University Medical School, Japan.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|January 1, 1993
PubMed
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Different dialyzers significantly impact blood oxygen levels during hemodialysis. While carbon dioxide and pH changes were minimal, dialyzer membrane characteristics influenced oxygen and bicarbonate loss.

Area of Science:

  • Nephrology
  • Physiology
  • Biomaterials

Background:

  • Hemodialysis involves artificial kidney (dialyzer) use to remove waste products and excess fluid.
  • Dialysate composition, particularly acetate, can influence blood gas balance during dialysis.
  • Dialyzer membrane properties may affect gas and solute exchange efficiency.

Purpose of the Study:

  • To compare the effects of seven different dialyzers on blood gas parameters during hemodialysis.
  • To investigate the influence of dialyzer membrane characteristics on gas exchange during dialysis.
  • To identify dialyzers that minimize adverse blood gas alterations.

Main Methods:

  • A multicenter, randomized crossover study involving five centers in four countries.
  • Seven different dialyzers were tested in patients undergoing hemodialysis with acetate-containing dialysate.

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  • Blood gas parameters (pO2, pCO2, pH, bicarbonate) were measured at 15 and 60 minutes post-dialysis initiation.

    • Main Results:

    • All dialyzers caused a significant decrease in partial pressure of oxygen (pO2), most pronounced at 60 minutes.
    • Filtral dialyzer showed the greatest pO2 reduction, while F 60 exhibited the least change.
    • Partial pressure of carbon dioxide (pCO2) and pH showed minimal and non-significant inter-dialyzer differences, though pH increased slightly at 60 minutes.
    • Calculated blood bicarbonate significantly decreased at 15 minutes and recovered by 60 minutes.
    • Filtral dialyzer demonstrated a larger loss of total carbon dioxide (CO2) compared to F 60, potentially linked to membrane properties.

    Conclusions:

    • Dialyzer choice significantly impacts oxygenation during hemodialysis, with F 60 showing a more favorable profile than Filtral.
    • Membrane characteristics appear to influence the diffusion of oxygen, carbon dioxide, and bicarbonate.
    • Hypoxemia during dialysis may result from multifactorial mechanisms including reflex hypoventilation and increased oxygen consumption, exacerbated by specific dialyzer types.