Cardiopulmonary events during hemodialysis: effects of dialysis membranes and dialysate buffers.
Adverse cardiac and pulmonary events are frequently observed during hemodialysis and contribute to significant morbidity and mortality. The temporal relationship between these events during the intradialytic period has not been well defined. To examine the event rate and timing of silent ischemia, cardiac ectopy, and hypoxemia, we conducted a prospective, single-blind, randomized study of 10 subjects undergoing maintenance hemodialysis with four contiguous combinations of dialysis membranes (cuprammonium or polysulfone) and dialysates (acetate or bicarbonate). The frequency of oxygen desaturation events peaked during the first 2 hours, whereas silent myocardial ischemia and supraventricular ectopies occurred more often in the later hours. Ventricular ectopy occurred steadily throughout the intradialytic period. The combination of acetate dialysis and cuprammonium membrane is associated with the most frequent events. We conclude that cardiopulmonary events can occur frequently during hemodialysis, and the frequency is dependent on the type of dialysis membrane and dialysate buffer used.
Munger
M A
MA
Department of Pharmacy Practice, Division of Nephrology and Hypertension, School of Medicine, University of Utah, Salt Lake City, UT 84112, USA. mmmunger@deans.pharm.utah.edu
Ateshkadi
A
A
Cheung
A K
AK
Flaharty
K K
KK
Stoddard
G J
GJ
Marshall
E H
EH
D000085:Acetates / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D001639:Bicarbonates / Q000009:adverse effects; D002021:Buffers; D002482:Cellulose / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D015312:Hemodialysis Solutions / Q000009:adverse effects*; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D010100:Oxygen / Q000097:blood; D011108:Polymers / Q000009:adverse effects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D016037:Single-Blind Method; D013450:Sulfones / Q000009:adverse effects
D000085:Acetates; D001639:Bicarbonates; D002021:Buffers; D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700; D002482:Cellulose; C009865:cuprammonium cellulose; D010100:Oxygen