Hemodynamic Studies, Acid‐Base Status and Osmolality in Different Hemodialysis Procedures

Abstract

Three patients on maintenance dialysis were each treated with 3 different procedures: 20 l recirculation dialysis with bicarbonate buffering, recirculation-adsorption dialysis and single-pass dialysis. Hemodynamic parameters were measured invasively and procedures A, B and C were compared for each patient. In this intra-individual comparative study, relationships were established between the varying hemodynamic parameters and the changes in osmolality and acid-base status. There were indications of some causal relationship to circulatory stability: in A and B, there were peripheral resistance increases of 24.5% and 38.4%, respectively, with stable circulation. In C, there was a 6.1% increase and unstable circulation. The influence of acidosis was shown in B, with disproportionately strong reductions of cardiac output (21.9%) and pulmonary artery pressure (44.9%). In spite of a decrease of osmolality (A: 15.6 milliosmoles/l), stable circulation could be achieved if the peripheral resistance was substantially increased and acid-base status was equalized.