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Titolo:
How can hemodialysis-associated hypotension and dialysis-induced symptoms be explained and controlled - particularly in diabetic and arterioscleroticpatients?
Autore:
Hampl, H; Berweck, S; Ludat, K; Fischer, HC; Hertel, J;
Indirizzi:
Humboldt Univ, Med Clin, Dept Nephrol & Intens Care Med, Berlin, Germany Humboldt Univ Berlin Germany Nephrol & Intens Care Med, Berlin, Germany
Titolo Testata:
CLINICAL NEPHROLOGY
, volume: 53, anno: 2000, supplemento:, 1
pagine: S69 - S79
SICI:
0301-0430(200002)53:<S69:HCHHAD>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
BICARBONATE;
Keywords:
bicarbonate; acidosis; PaCO2; circulation; hypotension; diabetes; arteriosclerosis; hemodialysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Hampl, H KfH Kuratorium Dialyse & Nierentransplantat EV, Dialyse Zentrum, Bismarckstr 97-98, D-10625 Berlin, Germany KfH Kuratorium Dialyse & Nierentransplantat EV Bismarckstr 97-98 Berlin Germany D-10625
Citazione:
H. Hampl et al., "How can hemodialysis-associated hypotension and dialysis-induced symptoms be explained and controlled - particularly in diabetic and arterioscleroticpatients?", CLIN NEPHR, 53, 2000, pp. S69-S79

Abstract

Patients with diabetes and/or severe arteriosclerosis are often unable to tolerate volume removal during hemodialysis (HD) and develop hemodialysis-induced symptoms. These problems can be omitted by well-balanced correction of I:he acid/base status. We compared 20 high-risk patients which were either treated with standard HD (dialysate bicarbonate 33 mmol/l, treatment A) or treated with standard HD and additional administration of NaHCO3 (120 - 160 mi 8.4% NaHCO3 solution over the venous line during HD) to correct the metabolic acidosis to upper normal values (treatment B). The following parameters were compared: 1. Acid/base status; 2. EEG monitoring and clinical observation of dialysis-induced symptoms; 3. Invasive monitoring of circulation by Swan-Ganz thermodilution; 4. Ventilation, oxygen consumption and lactate production. Optimal correction of acid/base values resulted in symptom-free hemodialysis sessions with stable PaCO2 in the normal range, cardiovascular stability assessed by invasive monitoring, normal ventilation and higher oxygen consumption and decreased lactate production. Optimal correction of acid/base balance further led to the absence of EEG alterations and ofdialysis-induced symptoms during treatment B as compared to treatment A. The baroreceptor response in these patients is usually disturbed due to sclerosis of the pressosensible vessels, especially the aortic arch and the pulmonary arteries impairing a compensatory increase of heart rate upon volumeremoval. However, chemoreceptors are able to increase sympathetic tone with preservation of blood pressure in this situation. In addition a decrease of PaO2 during volume removal can only be answered by an early increase of ventilation response due to stimulation of chemoreceptors provided that PaCO2 is maintained normal. Furthermore, normal cerebral blood flow also depends on a normal PaCO2. Based on these pathophysiological mechanisms the therapeutic strategy of additional bicarbonate administration to correct the acid/base status guarantees a stable normal PaCO2 and facilitates a symptom-free HD in high-risk patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 03:35:20