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      From Isolated Ultrafiltration to Blood-Temperature-Controlled Feedback: An Odyssey Started by Jonas Bergström

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          Most cited references 11

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          Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients.

          The relationship between blood pressure (BP) and mortality in hemodialysis patients has remained controversial. Some studies suggested that a lower pre- or postdialysis BP was associated with excess mortality, while others showed poorer outcome in patients with uncontrolled hypertension. We conducted a multicenter prospective cohort study to evaluate the impact of hemodialysis-associated hypotension on mortality. We recruited 1244 patients (685 males; mean age, 60 +/- 13 years) who underwent hemodialysis in 28 units during the two-year study period beginning in December 1999. Pre-, intra-, and postdialysis BP, and BP upon standing soon after hemodialysis, were measured in all patients at entry. Logistic regression analysis was used to assess the effect on mortality of pre-, intra-, and postdialysis BP, a fall in BP during hemodialysis, and a fall in BP upon standing soon after hemodialysis. During the study period, 149 patients died. Logistic models identified the lowest intradialysis systolic blood pressure (SBP) and degree of fall in SBP upon standing soon after hemodialysis as significant factors affecting mortality, but not pre- or postdialysis SBP and diastolic BP. The adjusted odds ratio for death was 0.79 (95% CI 0.64-0.98) when the lowest intradialysis SBP was analyzed in increments of 20 mm Hg, and was 0.82 (95% CI 0.67-0.98) when the fall in SBP upon standing soon after hemodialysis was analyzed in increments of 10 mm Hg. These results suggest that intradialysis hypotension and orthostatic hypotension after hemodialysis are significant and independent factors affecting mortality in hemodialysis patients.
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            The effects of control of thermal balance on vascular stability in hemodialysis patients: results of the European randomized clinical trial.

            Many reports note that the use of cool dialysate has a protective effect on blood pressure during hemodialysis (HD) treatments. However, formal clinical trials in which dialysate temperature is tailored to the body temperature of appropriately selected hypotension-prone patients are lacking. We investigated the effect of thermal control of dialysate on hemodynamic stability in hypotension-prone patients selected from 27 centers in nine European countries. Patients were eligible for the study if they had symptomatic hypotensive episodes in 25% or more of their HD sessions, assessed during a prospective screening phase over 1 month. The study is designed as a randomized crossover trial with two phases and two treatment arms, each phase lasting 4 weeks. We used a device allowing the regulation of thermal balance (Blood Temperature Monitor; Fresenius Medical Care, Bad Homberg, Germany), by which we compared a procedure aimed at preventing any transfer of thermal energy between dialysate and extracorporeal blood (thermoneutral dialysis) with a procedure aimed at keeping body temperature unchanged (isothermic dialysis). One hundred sixteen HD patients were enrolled, and 95 patients completed the study. During thermoneutral dialysis (energy flow rate: DeltaE = -0.22 +/- 0.29 kJ/kg x h), 6 of 12 treatments (median) were complicated by hypotension, whereas during isothermic dialysis (energy flow rate: DeltaE = -0.90 +/- 0.35 kJ/kg x h), the median decreased to 3 of 12 treatments (P < 0.001). Systolic and diastolic blood pressures and heart rate were more stable during the latter procedure. Isothermic dialysis was well tolerated by patients. Results show that active control of body temperature can significantly improve intradialytic tolerance in hypotension-prone patients. Copyright 2002 by the National Kidney Foundation, Inc.
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              Role of the venous system in hemodynamics during ultrafiltration and bicarbonate dialysis.

              A reduced venous compliance (VC) and inadequate venoconstriction may impair hemodynamics during hemodialysis, the first by impairing plasma volume preservation and by inducing a steep fall in central venous pressure (CVP) during minor plasma volume loss, the second by inadequate mobilization of hemodynamically inactive blood volume. For the protocol A, the relation between VC, the fall in plasma volume and the decline in central venous pressure (CVP) was assessed in 12 hemodialysis (HD) patients, aged 40 to 74 years, during isolated ultrafiltration (UF). The patients were ultrafiltrated for one hour at an UF rate of 1 to 1.5 liter/hr. VC was measured by strain gauge plethysmography with direct i.v. pressure measurements. CVP was assessed directly via a subclavian catheter. PVP was measured using the serial hematocrit method. VC correlated inversely with the fall in plasma volume (r = -0.66; P less than 0.025) and with the fall in CVP (corrected for UF volume) (r = -0.62; P less than 0.025). In the protocol B, the constriction of veins and resistance vessels was assessed sequentially during isolated UF and during UF combined with bicarbonate HD (UF + HD) by measuring the change in venous tone (VT) and vascular resistance (FVR) of the forearm. Twelve HD patients were studied (age 30 to 64 years). VT and FVR were measured using strain gauge plethysmography. The UF rate was equal during isolated UF and UF + HD (1 liter/hr). In six patients, the measurements were started with isolated UF and in six patients with UF + HD.(ABSTRACT TRUNCATED AT 250 WORDS)

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                February 2006
                15 February 2006
                : 24
                : 2
                : 218-221
                aUniversity Hospital Maastricht, Maastricht, The Netherlands; b25 Le Michelangelo 7, Avenue des Papalins, Monaco, Monte Carlo
                91015 Blood Purif 2006;24:218–221
                © 2006 S. Karger AG, Basel

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                Figures: 2, References: 22, Pages: 4
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