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Evolution of volume sensitivity during hemodialysis and ultrafiltration

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Abstract

Objective

This study aimed at assessing the evolution of cardiovascular characteristics during hemodialysis and ultrafiltration by a perturbation accurately defined in its magnitude and directly relevant to the problem of volume adjustment in stable hemodialysis patients.

Methods

Excess fluid volume was removed by constant ultrafiltration-rate as prescribed. Hemodynamic variables were continuously measured throughout treatments using non-invasive finger plethysmography. In addition to ongoing volume reduction by ultrafiltration (long-term perturbation), well-defined magnitudes of intravascular volume were transiently and reversibly sequestered (short-term perturbation) into the extracorporeal circulation at hourly intervals. Sensitivities of hemodynamic variables and of the baroreflex to the acute change in intravascular volume (volume sensitivities) were analyzed.

Results

Eight stable patients were assessed during two subsequent treatments. Treatments were accompanied by a decrease in cardiac output (p < 0.05) and stroke volume (p < 0.01), and by an increase in peripheral resistance (p < 0.05) and diastolic pressure (p < 0.05). Mean arterial pressure remained unchanged for the whole group but correlated with the change in total peripheral resistance in individual treatments (p < 0.01). The average volume sensitivity of mean arterial pressure was 11.9 ± 9.9 mmHg/L and increased (p < 0.01) during treatments, while the average volume sensitivity of heart rate remained unchanged at −7.9 ± 8.58 1/(min L). The corresponding volume sensitivity of the baroreflex was −0.81 ± 1.5 1/(min mmHg) and remained unchanged for the whole group, but the change correlated with the change in mean arterial pressure in individual treatments (p < 0.05).

Interpretation

The changes in arterial pressures during hemodialysis appear to relate to an unbalanced response of barocontrol mechanisms characterized by a compromised chronotropy and vascular over-reactivity.

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Acknowledgments

This work was supported by a grant from Fresenius Medical Care Deutschland GmbH. The funds for the Finometer were provided by the infrastructure grant UGP4 of the Austrian Ministry of Science, Education, and Art. We thank Prof. H. Holzer and the dialysis staff for the opportunity and support to conduct this study at the Division of Nephrology and Hemodialysis, Department of Internal Medicine, at the Medical University of Graz. We also thank G. Vogrinec from our institute for final processing of the video resource accompanying this paper.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Daniel Schneditz.

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Supplementary material 1 (MPG 49,716 kb)

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Wimmer, J., Batzel, J.J., Haditsch, B. et al. Evolution of volume sensitivity during hemodialysis and ultrafiltration. Clin Auton Res 21, 353–360 (2011) doi:10.1007/s10286-011-0122-x

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Keywords

  • Ultrafiltration
  • Blood volume
  • Blood pressure
  • Baroreflex
  • Renal replacement therapy