Vascular reactivity during haemodialysis and isolated ultrafiltration: thermal influences

Background. The present study was performed to assess the role of the extracorporeal blood temperature in the disparate cardiovascular response between isolated ultrafiltration and combined ultrafiltration-haemodialysis. Methods. In twelve stable dialysis patients (21–77 years), blood pressure and h...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 1995-10, Vol.10 (10), p.1852-1858
Main Authors: van Kuijk, W. H. M., Luik, A. J., de Leeuw, P. W., van Hooff, J. P., Nieman, F. H. M., Habets, H. M. L., Leunissen, K. M. L.
Format: Article
Language:English
Subjects:
extracorporeal blood temperature
forearm vascular resistance
forearm venous tone
hamemodialysis
isolated ultrafiltration
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Summary:Background. The present study was performed to assess the role of the extracorporeal blood temperature in the disparate cardiovascular response between isolated ultrafiltration and combined ultrafiltration-haemodialysis. Methods. In twelve stable dialysis patients (21–77 years), blood pressure and heart rate (Finapres) as well as forearm vascular resistance and venous tone (strain-gauge plethysmography) were measured during 1-h isolated ultrafiltration and 1-h combined ultrafiltration-haemodialysis (bicarbonate, sodium 141 mmol/l) at a fixed ultrafiltration rate of 0.91 l/h. The sequence of both treatment modalities was randomly defined within each patient. Serving as his or her own control, each patient was studied at two different dialysate temperatures: 37.5 and 35.0°C. Results. At a dialysate temperature of 35.0°C extra-corporeal blood cooling during combined ultrafiltration-haemodialysis was comparable to isolated ultrafiltration. The cardiovascular response in isolated ultrafiltration was characterized by a significant increase in both forearm vascular resistance and venous tone, while heart rate even decreased. As a result, blood pressure remained unchanged or even increased. In contrast, during combined ultrafiltration-haemodialysis at a dialysate temperature of 37.5°C the increase in forearm vascular resistance was only small and insignificant, while venous tone decreased significantly. Heart rate tended to increase. Combined ultrafiltration-haemodialysis at a dialysate temperature of 35.0°C was also associated with a small increase in forearm vascular resistance. However, venous tone remained stable while heart rate decreased. At both dialysate temperatures, blood pressure was well maintained. Conclusions. We conclude that differences in cardiovascular reactivity between isolated ultrafiltration and combined ultrafiltration-haemodialysis are only partially explained by differences in the extracorporeal blood temperature. In addition, especially venous reactivity is improved by lowering the dialysate temperature.
ISSN:0931-0509
1460-2385
DOI:10.1093/oxfordjournals.ndt.a090878