[Evaluation of plasma volume variation during different hemodialysis maneuvers].
Intradialytic hypotension is closely linked to hypovolemia and ascribed to the degree of ultrafiltration. Among the maneuvers used to recovery hypotension, we have the Trendelenburg position, the infusion of isotonic saline serum or plasma extenders as well as shutting of the ultrafiltration. The objective of this study is to quantify the influence that the different maneuvers employed for recovery hypovolemia will have on blood volume, employing the Crit-Line system. We have studied 32 hemodialysis patients over 5 consecutive hemodialysis sessions. The different maneuvers evaluated were: administration of saline serum, plasma extenders, Trendelenburg position, shutting off the ultrafiltration and administration of hypertonic saline serum.


RESULTS
The administration of saline serum causes an increase of 2.9% in blood volume at the end of the third hour, which is higher than the increase achieved in the first hour (2.6%) and second hour (2.4%). The Trendelenburg position achieves a minimal blood volume increase of 0.4%. The administration of plasma extenders achieves the most significant increase in blood volume of 3.1% and the longer lasting one as well (37 minutes). The cessation of ultrafiltration at the end of the first and third hours, achieves a blood volume increase of 2% and 2.3% respectively. Lastly, the administration of hypertonic saline serum causes a minimal blood volume increase of 0.7%.


CONCLUSIONS
The infusion of isotonic saline serum and plasma extenders, are the quickest, most efficient and long lasting maneuvers for blood volume expansion, followed by the cessation of ultrafiltration. In concerning to quick plasma volume recovery, the Trendelenburg position and the administration of hypertonic saline serum are not very efficient maneuvers.
Coll
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Servicio de Nefrología, Hospital Josep Trueta, Girona. ecoll@terra.com
Vallès
M
M
Torguet
P
P
Bronsoms
J
J
Maté
G
G
Mauri
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology*; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010953:Plasma Volume; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D014462:Ultrafiltration / Q000009:adverse effects
D007552:Isotonic Solutions