Cardiovascular instability during hemodialysis.
The major point of contention in the discussions following the formal panel presentation, both among members of the panel and the audience, was the role of sodium and its proper control while evaluating the effect of hemofiltration, sequential dialysis, and/or bicarbonate dialysis on cardiovascular instability. It appears that studies, carefully controlling the level of dialysate sodium, have not been performed, or reported in the literature. Hemodiafiltration, sequential dialysis, increased sodium dialysate and bicarbonate dialysate all seem to reduce the incidence and intensity of hypotension; however, the mechanisms have not yet been elucidated. Complications from these changes, particularly increased sodium must be considered. Methods of evaluation of underlying cardiac disease, autonomic neuropathy and hormonal changes were suggested. Use of equipment with newer membrane material, alterations of dialysis technique, were agreed as likely methods to combat the incidence and severity of cardiovascular instability. It is apparent from the discussion that there remain a number of areas to be investigated in evaluating the causes of hemodialysis-induced hypotension. Controlled studies, dissecting out each of the above noted factors, will be important in determining their relative importance in modification of future therapy.
D000085:Acetates / Q000494:pharmacology; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D001639:Bicarbonates / Q000494:pharmacology; D001672:Biocompatible Materials / Q000009:adverse effects; D001783:Blood Flow Velocity; D001810:Blood Volume; D002319:Cardiovascular System / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D009994:Osmolar Concentration; D006435:Renal Dialysis / Q000009:adverse effects*; D012964:Sodium / Q000494:pharmacology; D014462:Ultrafiltration
D000085:Acetates; D001639:Bicarbonates; D001672:Biocompatible Materials; D012964:Sodium