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      Impact of Profile Haemodialysis on Intra-/Extracellular Fluid Shifts and the Release of Vasoactive Hormones in Elderly Patients on Regular Dialysis Treatment

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          Abstract

          In 15 patients with end-stage renal failure and proven coronary heart disease, profile haemodialysis with decreasing ultrafiltration rate and hyperionic, decreasing dialysate solute concentration was compared with conventional, extracorporeal bicarbonate haemodialysis (Na<sup>+</sup><sub>D</sub> =138 mmol/l). Body fluid distribution and the release of vasoactive hormones (plasma renin activity, aldosterone, norepinephrine, epinephrine, and atrial natriuretic peptide) were investigated. Haemodialysis with constant ultrafiltration rate and constant dialysate composition (A) was followed by two dialysis profiles: decreasing ultrafiltration rate (B) and additional hyperionic, decreasing dialysate sodium concentration (C). In all 15 patients, the dialysis procedures (A) – (C) were used for 2 weeks each with six sessions, the last being taken for investigation. Body fluid distribution was calculated. In patients with serum sodium above 136 mmol/l, the conventional dialysis (A) as well as the Uf profile (B) showed a net fluid shift from extracellular volume (ECV) to intracellular volume (ICV). Using the profile with hyperionic, decreasing Na<sup>+</sup>D (C), the reverse fluid shift with decreasing ICV was achieved not only in those with serum Na<sup>+</sup> < 136 mmol/l, but also in those with serum Na<sup>+</sup> ≥ 136 mmol/l. The release of vasoactive hormones decreased already at profile haemodialysis (B) compared with (A) and was further reduced in (C). These results would suggest, profile dialyses B and C to have less impact on the cardiovascular system in elderly patients assuming higher patient comfort compared with the standard dialysis procedure. A higher benefit was obtained in C compared with B, presumably due to the additional prevention of the ICV shift and plasma volume depletion in patients with initial serum sodium ≥ 136 mmol/l using transiently hyperionic Na<sup>+</sup><sub>D</sub>. These results show that in elderly patients, hyperionic profile haemodialysis (Na<sup>+</sup><sub>D</sub> > Na<sup>+</sup>s) had less impact on cardiovascular regulation than conventional bicarbonate dialysis.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1997
          1997
          19 December 2008
          : 75
          : 3
          : 264-271
          Affiliations
          Departments of aNephrology and bGastroenterology and Endocrinology, Centre of Internal Medicine, Philipps University, Marburg, Germany
          Article
          189547 Nephron 1997;75:264–271
          10.1159/000189547
          9069446
          © 1997 S. Karger AG, Basel

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          Page count
          Pages: 8
          Categories
          Original Paper

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