Specific effect of the infusion of glucose on blood volume during haemodialysis.
BACKGROUND
Intradialytic morbid events such as hypotension and cramps during haemodialysis are generally treated by infusion of iso- or hypertonic solutions. However, differences may exist between solutions with respect to plasma refilling and vascular reactivity.


METHODS
We compared the effect of no infusion (NI) with isovolumetric infusion of isotonic saline 0.9% (IS), saline 3% (HS), isotonic glucose 5% (IG), glucose 20% (HG) and mannitol 20% (HM), in six patients during the first hour of six standardized haemodialysis sessions with ultrafiltration. Relative blood volume was monitored continuously by measurement of the intravascular amount of protein. Blood pressure was measured by an oscillometric method, while cardiac output was measured by a thoracic impedance technique.


RESULTS
At baseline, no differences in serum urea, sodium, potassium, glucose and osmolarity were found between the various infusion experiments. The maximum increase in relative blood volume directly after infusion was significantly greater with HG (5.1+/-0.7%) than with all other infusions (P<0.05). Stroke volume increased (21.0+/-19.2%, P<0.05) and total peripheral resistance decreased significantly (15.4+/-16.4%, P<0.05) after HG infusions.


CONCLUSIONS
Infusion of hypertonic glucose during dialysis results in a greater increase in relative blood volume (RBV) than equal volumes of other solutions. As mannitol has the same osmolarity, molecule mass and charge, the greater increase in RBV following hypertonic glucose appears to be a specific effect, possibly related to a decline in vascular tone. It is therefore uncertain whether the observed increase in plasma volume during hypertonic glucose infusions will be of clinical benefit.
Nette
Robert W
RW
Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands. zietse@inwl.azr.nl
Krepel
Harmen P
HP
van den Meiracker
Anton H
AH
Weimar
Willem
W
Zietse
Robert
R
D000328:Adult; D001794:Blood Pressure; D001798:Blood Proteins / Q000032:analysis; D001810:Blood Volume / Q000187:drug effects; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D008991:Monitoring, Physiologic; D006435:Renal Dialysis; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D014462:Ultrafiltration
D001798:Blood Proteins; D008353:Mannitol; D012965:Sodium Chloride; D005947:Glucose