Acute Problems during Hemodialysis

  • C. M. Kjellstrand


The outcomes of chronic hemodialysis have improved greatly during the last 15 years. This improvement has taken place without any real “breakthrough” in our understanding of performance of dialysis. It seems to represent the cumulative results of small technical improvements, the “shuffling of details,” and the tendency to increase the frequency of dialysis from 2 to 3 times weekly. The improvement is very real. The first-year mortality has decreased from 50% to 14% (Table 1). This is astounding, particularly as mean patient age has increased markedly and the percentage of patients with systemic complicated diseases has increased markedly.


Autonomic Neuropathy Chronic Hemodialysis Pathogenetic Factor Acute Problem Hypotensive Episode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kjellstrand CM, Evans RL: Considerations of new dialysis schedules: Theoretical evaluation and review of literature, in: Maiorca R, Lindholm T (eds): Gardia Meeting on Short Dialysis. Lund, Sweden, Rahmus, 1975, pp 26–37.Google Scholar
  2. 2.
    Rosa A, Fryd DS, Kjellstrand CM: Dialysis symptoms and stabilization on chronic dialysis—practical application of the Cusum plot. Arch Intern Med 140:804–807, 1980.PubMedCrossRefGoogle Scholar
  3. 3.
    Wehle B, Asaba H, Castenfors J, Fürst P, Grahn A, Gunnarsson B, Shaldon S, Bergstrom J: The influence of dialysis fluid composition on the blood pressure response during dialysis. Clin Nephrol 10:62–66, 1978.PubMedGoogle Scholar
  4. 4.
    Rodrigo F, Shideman J, McHugh R, Buselmeier T, Kjellstrand C: Osmolality changes during hemodialysis—natural history, clinical correlations, and influence of dialysate glucose and intravenous mannitol. Ann Intern Med 86:554–561, 1977.PubMedGoogle Scholar
  5. 5.
    Graefe U, Milutinovich J, Follette WC, Vizzo JE, Babb AL, Scribner BH: Less dialysis-induced morbidity and vascular instability with bicarbonate in dialysate. Ann Intern Med 88:332–336, 1978.PubMedGoogle Scholar
  6. 6.
    Hagstam KE, Lindergord B, Tabbling G: Mannitol influence in regular hemodialysis. Treatment for chronic renal insufficiency. Scand J Urol Nephrol 3:257–263, 1969.PubMedCrossRefGoogle Scholar
  7. 7.
    Wilkinson R, Barber SG, Robson V: Cramps, thirst and hypertension in hemodialysis patients—the influence of dialysate sodium concentration. Clin Nephrol 7:101–105, 1977.PubMedGoogle Scholar
  8. 8.
    Uriarte AL, Gamez CL, Valenzuela SL: Hypotension arterial durante hemodialisis con sodio bajo en ninos, in: Abstracts Sociedad Mexicana de Nefrologia—XI Annual Meeting, 1977.Google Scholar
  9. 9.
    Degoulet P, Roulx J-P, Aime F, Berger C, Bloch P, Goupy F, Legrain M: Programme dialyse—informatique III. Donnees epidemiologiques strategies de dialyse et résultats biologiques. J Urol Nephrol 82:1001–1042, 1976.Google Scholar
  10. 10.
    Kersh ES, Kronfield SJ, Unger A, Popper RW, Cantor S, Cohn K: Autonomic insufficiency in uremia as a cause of hemodialysis-induced hypotension. N Engl J Med 290:650–653, 1974.PubMedCrossRefGoogle Scholar
  11. 11.
    Nies AS, Robertson D, Stone WJ: Hemodialysis hypotension is not the result of uremic peripheral autonomic neuropathy. J Lab Clin Med 94:395–402, 1979.PubMedGoogle Scholar
  12. 12.
    Kjellstrand CM, Rosa AA, Shideman JR: Hypotension during hemodialysis—osmolality fall is an important pathogenetic factor. ASAIO J 3:11–19, 1980.Google Scholar
  13. 13.
    Ing TS, Ashbach DL, Kanter A, Oyama JH, Armbruster KFW, Merkel FK: Fluid removal with negative-pressure hydrostatic ultrafiltration using a partial vacuum. Nephron 14:451–455, 1975.PubMedCrossRefGoogle Scholar
  14. 14.
    Bergstrom J, Asaba H, Furst P, Oules R: Dialysis, ultrafiltration, and blood pressure, in Robinson B (ed): Dialysis and Renal Transplantation. London, Pitman Press, 1977, vol 13.Google Scholar
  15. 15.
    Levine J, Falk B, Henriquez M, Raja RM, Kramer MS, Rosenbaum JL: Effects of varying dialysate sodium using large surface area dialyzers. Tr Am Soc Artif Intern Organs 24:139–141, 1978.Google Scholar
  16. 16.
    Boquin E, Parnell S, Grondin G, Wollard C, Leonard D, Michales R, Levin NW: Crossover study of the effects of different dialysate sodium concentrations in large surface area, short-term dialysis. Proc Clin Dial Transpl Forum 7:48–52, 1977.Google Scholar
  17. 17.
    Gurich W, Mann H, Stiller S, Hacke W: Sodium elimination and alterations of the EEG during dialysis. Artif Organs 3(A): 15, 1979.Google Scholar
  18. 18.
    Van Stone JC, Cook J: Decreased postdialysis fatigue with increased dialysate sodium concentration. Proc Clin Dial Transpl Forum 8:152–156, 1978.Google Scholar
  19. 19.
    Ogden DA: A double blind crossover comparison of high and low sodium dialysis. Proc Clin Dial Transpl Forum 8:157–165, 1978.Google Scholar
  20. 20.
    Raja R, Henriquez M, Kramer M, Rosenbaum JL: Hypertonic glucose, mannitol and saline infusion in hemodialysis. Artif Organs 3(A):37, 1979.Google Scholar
  21. 21.
    Locatelli F, Costanzo R, Di Filippo S, Pedrini L, Marai P, Pozzi C, Ponti R, Sforzini S, Redaelli B: Ultrafiltration and high sodium concentration dialysis: Pathophysiological correlation. Proc Eur Dial Transpl Assoc 15:253–259, 1978.Google Scholar
  22. 22.
    Robson M, Oren A, Ravid M: Dialysate sodium concentration, hypertension, and pulmonary edema in hemodialysis patients. Dial Transpl 7:678–679, 1978.Google Scholar
  23. 23.
    Stewart WK, Fleming LW, Manuel MA: Benefits obtained by the use of high sodium dialysate during maintenance haemodialysis. Proc Eur Dial Transpl Assoc 9:111–116, 1972.Google Scholar
  24. 24.
    Locatelli F, Costanzo R, Di Filippo S: High sodium dialysate. Int J Artif Organs 2:171, 1979.PubMedGoogle Scholar
  25. 25.
    Raja R, Henriquez M, Kramer M, Rosenbaum JL: Intradialytic hypotension—role of osmolar changes and acetate influx. Tr Am Soc Artif Intern Organs 25:419–421, 1979.CrossRefGoogle Scholar
  26. 26.
    Dumler F, Grondin G, Levin NW: Sequential high/low sodium hemodialysis: An alternative to ultrafiltration. Tr Am Soc Artif Intern Organs 25:351–353, 1979.CrossRefGoogle Scholar
  27. 27.
    Leski M, Niethammer T, Wyss T: Glucose-enriched dialysate and tolerance to maintenance hemodialysis. Nephron 24:271–273, 1979.PubMedCrossRefGoogle Scholar
  28. 28.
    Zucchelli P, Catizone L, Esposti ED, Fusaroli M, Ligabue A, Zuccaia A: Influence of ultrafiltration on plasma renin activity and adrenergic system. Nephron 21:317–324, 1978.PubMedCrossRefGoogle Scholar
  29. 29.
    Cannella G, Picotti GB, Mioni G, Cristinelli L, Maiorca R: Blood pressure behaviors during dialysis and ultrafiltration. A pathogenic hypothesis on hemodialysis-induced hypotension. Int J Artif Organs 1:69–75, 1978.PubMedGoogle Scholar
  30. 30.
    Brecht HM, Ernst W, Koch KM: Plasma noradrenaline levels in regular hemodialysis patients. Proc Eur Dial Transpl Assoc 12:281–290, 1976.Google Scholar
  31. 31.
    Hamp H: Hemodialysis induced hypotension. Int J Artif Organs 2:43–44, 1979.Google Scholar
  32. 32.
    Korchik WP, Brown DC, DeMaster EG: Hemodialysis induced hypotension. Int J Artif Organs 1:151, 1978.PubMedGoogle Scholar
  33. 33.
    Korchik WP, DeMaster EG, Brown DC: Plasma norepinephrine and hemodialysis. Kidney Int 12:484, 1977 (abstract).Google Scholar
  34. 34.
    Ksiqzek A: Dopamine-beta-hydroxylase activity and catecholamine levels in the plasma of patients with renal failure. Nephron 24:170–173, 1979.CrossRefGoogle Scholar
  35. 35.
    Graefe U, Milutinovich J, Follette WC, Babb AL, Scribner BH: Improved tolerance to rapid ultrafiltration with the use of bicarbonate in dialysate. Proc Eur Dial Transpl Assoc 14:153–159, 1977.Google Scholar
  36. 36.
    Van Stone JC, Cook J: The effect of replacing acetate with bicarbonate in the dialysate of stable chronic hemodialysis patients. Proc Clin Dial Transpl Forum 8:103–105, 1978.Google Scholar
  37. 37.
    Shaldon S, Deschodt G, Beau MC, Claret G, Mion H, Mion C: Vascular resistance and stability during high flux haemofiltration compared to haemodialysis. Abstr Am Soc Nephrol 12:129A, 1979.Google Scholar
  38. 38.
    Aljama P, Bird PAE, Ward MK, Feest TG, Walker W, Tanboga H, Sussman M, Kerr DNS: Haemodialysis-induced leucopenia and activation of complement: Effects of different membranes. Proc Eur Dial Transpl Assoc 15:144–153, 1978.Google Scholar
  39. 39.
    Nord E, Danovitch GM: Vasopressin response in hemodialysis patients. Kidney Int 16:234, 1979.Google Scholar
  40. 40.
    Schrier RW, Berl T, Anderson RJ: Osmotic and nonosmotic control of vasopressin release. Am J Physiol 236:F321–F332, 1979.PubMedGoogle Scholar
  41. 41.
    Raij L, Wrigley B: Increase in angiotensin converting enzyme during hemodialysis. Abstr Am Soc Nephrol 11:49A, 1978.Google Scholar
  42. 42.
    Remuzzi G, Cavenaghi AE, Mecca G, Donati MB, de Gaetano G: Prostacyclin-like activity and bleeding in renal failure. Lancet 2:1195, 1977.PubMedCrossRefGoogle Scholar
  43. 43.
    Remuzzi G, Marchesi D, Cavenaghi AE, Livio M, Conati MB, de Gaetano G, Mecca G: Bleeding in renal failure: A possible role of vascular prostacyclin. Clin Nephrol 12:127–131, 1979.PubMedGoogle Scholar
  44. 44.
    Szczeklik A, Nizankowski R, Skawinski S, Sczceklik J, Gluszko P, Gryglewski RJ: Successful therapy of advanced arteriosclerosis obliterans with prostacyclin. Lancet 1:1111, 1979.PubMedCrossRefGoogle Scholar
  45. 45.
    Casals-Stenzel J, Morton JJ: The vasodepressor action of prostacyclin and its effect on plasma angiotensin II and vasopressin in unanaesthetized normotensive and hypertensive rats. Clin Exp Hypertension 1:577–596, 1979.CrossRefGoogle Scholar
  46. 46.
    Lynch RE, Bosl RH, Streifel AJ, Ebben JP, Ehlers SM, Kjellstrand CM: Dialysis thrombocytopenia: Parallel plate vs hollow fiber dialyzers. Tr Am Soc Artif Intern Organs 24:704–708, 1978.Google Scholar
  47. 47.
    Prosser D, Parsons V: The case for a specific uraemic myocardiopathy. Nephron 15:4–7, 1975.PubMedCrossRefGoogle Scholar
  48. 48.
    Ejerblad S, Eriksson I, Johansson H: Uraemic arterial disease. ScandJ Urol Nephrol 13:161–169, 1979.CrossRefGoogle Scholar
  49. 49.
    Ibels LS, Alfrey AC, Huffer WE, Craswell PW, Anderson JT, Weil R: Arterial calcification and pathology in uremic patients undergoing dialysis. Am J Med 66:790–796, 1979.PubMedCrossRefGoogle Scholar
  50. 50.
    de Fremont JF, Coevoet B, Andrejak M, Makdassi R, Quichaud J, Lambrey G, Guéris J, Caillens C, Harichaux P, Alexandre JM, Fournier A: Effects of antihypertensive drugs on dialysis-resistant hypertension, plasma renin and dopamine betahydroxylase activities, metabolic risk factors and calcium phosphate homeostasis: Comparison of metoprolol, alphamethylodopa and Clonidine in a cross-over trial. Clin Nephrol 12:198–205, 1979.PubMedGoogle Scholar
  51. 51.
    Lentz RD, Brown DM, Kjellstrand CM: Treatment of severe hypophosphatemia. Ann Intern Med 89:941–944, 1978.PubMedGoogle Scholar
  52. 52.
    Wing AJ, Brunner FP, Brynger H, Chantier C, Donckerwolcke RA, Gurland HJ, Hathway RA, Jacobs CJ, Seiwood NH: Combined report on regular dialysis and transplantation in Europe, VIII, 1977. Proc Eur Dial Transpl Assoc 15:4–76, 1978.Google Scholar
  53. 53.
    Kjellstrand CM, Arieff AI, Friedman EA, Furst P, Henderson LW, Massry SG: Inadequacy of dialysis: Why patients are not well. Tr Am Soc Artif Intern Organs 25:518–520, 1979.CrossRefGoogle Scholar
  54. 54.
    Kjellstrand CM: Current problems in long-term hemodialysis, in: Proceedings of the First Asian Pacific Congress of Nephrology, pp 169–183, 1979.Google Scholar

Copyright information

© Plenum Publishing Corporation 1985

Authors and Affiliations

  • C. M. Kjellstrand
    • 1
  1. 1.Division of Nephrology, Department of MedicineHennepin County Medical CenterMinneapolisUSA

Personalised recommendations