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      Compartment Effects in Hemodialysis

      1 , 2

      Seminars in Dialysis

      Wiley

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          Most cited references 21

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          Theory and validation of access flow measurement by dilution technique during hemodialysis.

          The theory shows that access flow can be measured by the dilution technique by reversal of the blood dialysis lines with the venous outlet facing the access stream: (1.) with one dilution sensor in arterial line and two injections Equation (6); (2.) with two matched dilution sensors on the venous line and on the arterial line and one injection Equation (8); (3.) with blood sampling as for recirculation measurement using BUN or other methods in Equation (12). In all cases, accurate measurement of hemodialysis blood flow is required. The results of this bench validation demonstrate that dialysis blood flows, in the clinical range of 200 to 350 ml/min or more, create good mixing conditions in a vascular access model. Accurate measurements are provided for all clinically significant ranges of access flows, needle positions, and vascular access inner diameters. This simple, non-invasive, and inexpensive technique shows great promise for routine diagnosis of vascular access failure in hemodialysis patients.
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            The effect of exercise during haemodialysis on solute removal.

            Urea rebound results as urea re-equilibrates between intracellular and intravascular compartments post haemodialysis. The mechanism of the rebound is thought to be due to either a reduced diffusion rate or blood flow. It is hypothesized that low blood flow in the skeletal muscles might be responsible. We tested this by studying the effect of exercise during dialysis on the removal of urea, creatinine and potassium. Eleven patients (aged 32-78 years) on haemodialysis (4-58 months) were studied on paired dialysis sessions; one with exercise and the other as a control. Patients pedalled on a cycle for 5-20 min at submaximal workload followed by 10 min rest to achieve a total of 60 min exercise. Plasma concentrations of urea, creatinine and potassium were measured pre-, post- and 30-min post dialysis. The post-dialysis rebound (% rebound) and reduction ratios (RR) of the solutes and equilibrated (two-pool) urea Kt/V were calculated for comparison. The rebound of all three solutes was reduced significantly following exercise. The rebound of urea decreased from 12.4 to 10.9% (median, P<0.01 Wilcoxon signed rank test), creatinine from 21.2 to 17.2% (P<0.001) and potassium from 62 to 44% (P<0.05). Kt/V and RR increased significantly as a result: Kt/V urea from 1.00 to 1.15 (P=0.001), RR urea from 0.63 to 0.68 (P<0.001); Kt/V creatinine from 0.71 to 0.84 (P<0.01); and RR creatinine from 0.51 to 0.57 (P<0.05). Exercise increased the efficiency of dialysis by reducing the rebound of solutes due to increased perfusion of the skeletal muscles.
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              Overestimation of Hemodialysis Dose Depends on Dialysis Efficiency by Regional Blood Flow but not by Conventional Two Pool Urea Kinetic Analysis

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                Author and article information

                Journal
                Seminars in Dialysis
                Seminars in Dialysis
                Wiley
                0894-0959
                1525-139X
                July 07 2008
                July 2001
                July 07 2008
                July 2001
                : 14
                : 4
                : 271-277
                Affiliations
                [1 ]Department of Physiology, Karl‐Franzens University, Graz, Austria, and
                [2 ]VA Chicago Westside Division, University of Illinois at Chicago, Chicago, Illinois
                Article
                10.1046/j.1525-139X.2001.00066.x
                © 2001

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