Haemodynamics and electrolyte balance: a comparison between on-line pre-dilution haemofiltration and haemodialysis

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2004-09, Vol.19 (9), p.2354-2359
• Main Authors: Beerenhout, Charles, Dejagere, Tom, van der Sande, Frank M., Bekers, Otto, Leunissen, Karel M., Kooman, Jeroen P.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; central blood volume; electrolyte balance; Emergency and intensive care: renal failure. Dialysis management; Female; haemodialysis; haemofiltration; Hemodynamics - physiology; Hemofiltration - methods; Humans; Intensive care medicine; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; on-line pre-dilution; Renal Dialysis - methods; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Temperature; Treatment Outcome; vascular resistance; Water-Electrolyte Balance - physiology
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfh315

Background. An important advantage of convective therapies is improved vascular reactivity. However, it is not well known whether the vascular response during convective therapies remains superior when compared to haemodialysis (HD) with an adjusted temperature of the dialysate. It has also been suggested that convective therapies may impair small electrolyte removal through an effect on the Donnan equilibrium. In the present study, we compared the haemodynamic response and small electrolyte removal between pre-dilution on-line haemofiltration (HF) and HD procedures. Methods. Cardiac output (CO), central blood volume (CBV) and peripheral vascular resistance (PVR) were assessed, using the saline dilution technique, in 12 stable patients during HF and HD with two different temperatures of the dialysate [36.5 and 35.5°C (HD36.5 and HD35.5)]. Balances for sodium, potassium, calcium and conductivity were assessed using total dialysate/filtrate collections. Target filtration volume for HF was 1.2 times body weight. The temperature of the infusate was 36.5°C. Results. The change (Δ) in CBV was less during HD with a dialysate temperature of 35.5°C (−0.03±0.14 l; P