Hemodynamic Behavior During Hemo-dialysis: Effects of Dialysate Concentrations of Bicarbonate and Potassium
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Citações na Scopus
15
Tipo de produção
article
Data de publicação
2014
Título da Revista
ISSN da Revista
Título do Volume
Editora
KARGER
Citação
KIDNEY & BLOOD PRESSURE RESEARCH, v.39, n.5, p.490-496, 2014
Resumo
Background/Aims: Ultrafiltration that occurs during hemodialysis (HD) promotes profound alterations in a relatively short period of time. The dialysate content of bicarbonate (DBic) and potassium (DK) may have impact over intradialytic hemodynamics, which goes beyond ultrafiltration, and its impact was evaluated in a prospective cohort. Methods: 30 patients under HD were submitted to hemodynamic assessment (HA) at the beginning and at the end of HD sessions, through a non-invasive method. Serum minus dialysate potassium concentration was expressed as K-Gap. Cardiac index (CI) and peripheral arterial resistance (PAR) variation (post-HD minus pre-HD) were expressed as Delta CI and Delta PAR. Dialysate content of sodium and calcium were expressed as DNa and DCa, respectively. Results: Mean DNa, DK and DBic were, respectively, 136.4 +/- 1.1, 2.1 +/- 0.6 and 38.2 +/- 2.1 mEq/L. In 15 patients, DCa was > 1.5 mmol/L and in the other 15 patients <= 1.5 mmol/L. The K-Gap ranged from 1.4 to 5.1 mEq/l (median 3.0 mEq/L). There was a reduction in post-HD CI and systolic blood pressure (Delta CI = -0.72l/min/m(2) and -11.3 +/- 15.1 mmHg, respectively, p < 0.001 for both). Conversely, Delta PAR increased (Delta PAR = 272dyn.s/cm(5), p < 0.001). Lower post-HD CI was was associated to higher DBic (p = 0.0013) and lower K-Gap (p = 0.026). In multivariate analysis, Delta CI was dependent on DBic and K-Gap, whereas Delta PAR was dependent on dialysate calcium during HD. Conclusion: We confirmed that Na and Ca dialysate content exerts and important role on hemodynamic during HD. In addition, our findings pointed out that higher dialysate concentrations of bicarbonate and potassium promote lower cardiac performance at the end of hemodialysis session.
Palavras-chave
Hemodialysis, Bicarbonate, Potassium, Hemodynamic, Peripheral arterial resistance, Dialysate
Referências
- Block GA, 2004, J AM SOC NEPHROL, V15, P2208, DOI 10.1097/01.ASN.0000133041.27682.A2
- BRACE RA, 1974, AM J PHYSIOL, V227, P590
- Chazot C, 2012, NEPHROL DIAL TRANSPL, V27, P2404, DOI 10.1093/ndt/gfr678
- Daugirdas J T, 1995, Adv Ren Replace Ther, V2, P295
- EISNER DA, 1979, J PHYSIOL-LONDON, V294, P255
- FITZOVICH DE, 1991, J AM COLL CARDIOL, V18, P1105
- Gabutti L, 2003, NEPHROL DIAL TRANSPL, V18, P2369, DOI 10.1093/ndt/gfg383
- Gabutti L, 2009, NEPHROL DIAL TRANSPL, V24, P973, DOI 10.1093/ndt/gfn541
- Gabutti L, 2009, BMC NEPHROL, V10, DOI 10.1186/1471-2369-10-7
- Gabutti L, 2011, BMC NEPHROL, V12, DOI 10.1186/1471-2369-12-14
- Gasser JA, 2014, AM J PHYSIOL-RENAL, V306, pF517, DOI 10.1152/ajprenal.00494.2013
- Haddy FJ, 2006, AM J PHYSIOL-REG I, V290, pR546, DOI 10.1152/ajpregu.00491.2005
- Heguilen RM, 2005, NEPHROL DIAL TRANSPL, V20, P591, DOI 10.1093/ndt/gfh661
- HOU S, 1989, AM J KIDNEY DIS, V13, P137
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group, 2013, KIDNEY INT, V3, pS1
- KRAUT JA, 1986, KIDNEY INT, V30, P694, DOI 10.1038/ki.1986.242
- Locatelli F, 2004, NEPHROL DIAL TRANSPL, V19, P785, DOI 10.1093/ndt/gfh102
- McIntyre CW, 2010, BLOOD PURIFICAT, V29, P105, DOI 10.1159/000245634
- NG YC, 1987, AM J PHYSIOL, V252, pH1005
- OETTINGER CW, 1993, J AM SOC NEPHROL, V3, P1804
- Riddez L, 1997, CRIT CARE MED, V25, P635, DOI 10.1097/00003246-199704000-00013
- Santoro A, 2008, NEPHROL DIAL TRANSPL, V23, P1415, DOI 10.1093/ndt/gfm730
- Tentori F, 2013, AM J KIDNEY DIS, V62, P738, DOI 10.1053/j.ajkd.2013.03.035
- Wizemann V, 2009, NEPHROL DIAL TRANSPL, V24, P1574, DOI 10.1093/ndt/gfn707
- Workeneh BT, 2010, AM J CLIN NUTR, V91, P1128