Unphysiology Is the Major Factor Influencing Cardiovascular Instability during Hemodialysis
Identifieur interne : 002762 ( Main/Exploration ); précédent : 002761; suivant : 002763Unphysiology Is the Major Factor Influencing Cardiovascular Instability during Hemodialysis
Auteurs : C. M. Kjellstrand [États-Unis] ; T. Ing [États-Unis] ; C. R. Blagg [États-Unis]Source :
- Hemodialysis International [ 1492-7535 ] ; 2004-01.
Abstract
Background: Hemodialysis is often complicated by cardiovascular instability (CVI). We studied factors contributing to this problem during 720 hemodialyses (HDs) in 20 patients; 480 dialyses were 6/week and 240 were 3/week. Methods: Dependent variables were increase in pulse rate (PR) and maximal (MAX) and overall (OV) fall of systolic blood pressure (BP). Independent variables were dialyses/week (DIAL), ultrafiltration (Uf), % of body weight (BW), pre‐post BUN (ΔBUN), time on dialysis (T), speed of dialysis (K/V in mL min–1 kg–1 BW), target‐postdialysis BW (Ta‐Po BW), Kt/V, ΔPO4, Δbicarbonate, Δpotassium, ΔBUN, an ‘unphysiology index’ summing up changes in electrolytes, and BUN and BW during dialysis (UPI). The relations were analyzed by backward multiple regression analysis. Results: PR increased 0.5 ± 11/min; MAX BP fall was 23 ± 17 mmHg; OV BP fall was 12 ± 19 mmHg. In multiple stepwise backward regression analysis, independents in order of importance: PR = 38 – DIAL × 4 + T × 0.1 + Uf × 1.8 +ΔPO4 × 1.8 – UPI× 0.2 – K/V × 2, r = 0.30, p < 0.0001; MAX BP = UPI × 0.4 – ΔBUN × 0.3 + ΔPO4 × 2.6 + 11, r = 0.34, p < 0.0001; OV BP = UPI × 0.4 – ΔBUN × 0.3 +ΔPO4 × 2.7 + 1, r = 0.33, p < 0.0001. Conclusion: To prevent BP fall and tachycardia during hemodialysis, the most important factor to decrease is unphysiology, i.e., the oscillations in electrolytes, fluid spaces, and osmolality that occur during dialysis. The best way to do this is to dialyze patients daily. An unexpected finding worthy of further investigation was the large detrimental influence of ΔPO4 on CVI.
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DOI: 10.1111/j.1492-7535.2004.0085ai.x
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M." last="Kjellstrand">C. M. Kjellstrand</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Illinois</region></placeName><wicri:cityArea>Aksys Ltd., Lincolnshire</wicri:cityArea></affiliation></author><author><name sortKey="Ing, T" sort="Ing, T" uniqKey="Ing T" first="T." last="Ing">T. Ing</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Illinois</region></placeName><wicri:cityArea>Loyola University Medical School, Chicago</wicri:cityArea></affiliation></author><author><name sortKey="Blagg, C R" sort="Blagg, C R" uniqKey="Blagg C" first="C. R." last="Blagg">C. R. Blagg</name><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Hemodialysis International</title><title level="j" type="alt">HEMODIALYSIS INTERNATIONAL</title><idno type="ISSN">1492-7535</idno><idno type="eISSN">1542-4758</idno><imprint><biblScope unit="vol">8</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="91">91</biblScope><biblScope unit="page" to="92">92</biblScope><biblScope unit="page-count">100</biblScope><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK; Malden, USA</pubPlace><date type="published" when="2004-01">2004-01</date></imprint><idno type="ISSN">1492-7535</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1492-7535</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Hemodialysis is often complicated by cardiovascular instability (CVI). We studied factors contributing to this problem during 720 hemodialyses (HDs) in 20 patients; 480 dialyses were 6/week and 240 were 3/week. Methods: Dependent variables were increase in pulse rate (PR) and maximal (MAX) and overall (OV) fall of systolic blood pressure (BP). Independent variables were dialyses/week (DIAL), ultrafiltration (Uf), % of body weight (BW), pre‐post BUN (ΔBUN), time on dialysis (T), speed of dialysis (K/V in mL min–1 kg–1 BW), target‐postdialysis BW (Ta‐Po BW), Kt/V, ΔPO4, Δbicarbonate, Δpotassium, ΔBUN, an ‘unphysiology index’ summing up changes in electrolytes, and BUN and BW during dialysis (UPI). The relations were analyzed by backward multiple regression analysis. Results: PR increased 0.5 ± 11/min; MAX BP fall was 23 ± 17 mmHg; OV BP fall was 12 ± 19 mmHg. In multiple stepwise backward regression analysis, independents in order of importance: PR = 38 – DIAL × 4 + T × 0.1 + Uf × 1.8 +ΔPO4 × 1.8 – UPI× 0.2 – K/V × 2, r = 0.30, p < 0.0001; MAX BP = UPI × 0.4 – ΔBUN × 0.3 + ΔPO4 × 2.6 + 11, r = 0.34, p < 0.0001; OV BP = UPI × 0.4 – ΔBUN × 0.3 +ΔPO4 × 2.7 + 1, r = 0.33, p < 0.0001. Conclusion: To prevent BP fall and tachycardia during hemodialysis, the most important factor to decrease is unphysiology, i.e., the oscillations in electrolytes, fluid spaces, and osmolality that occur during dialysis. The best way to do this is to dialyze patients daily. An unexpected finding worthy of further investigation was the large detrimental influence of ΔPO4 on CVI.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Illinois</li><li>Washington (État)</li></region><settlement><li>Seattle</li></settlement><orgName><li>Université de Washington</li></orgName></list><tree><country name="États-Unis"><region name="Illinois"><name sortKey="Kjellstrand, C M" sort="Kjellstrand, C M" uniqKey="Kjellstrand C" first="C. M." last="Kjellstrand">C. M. Kjellstrand</name></region><name sortKey="Blagg, C R" sort="Blagg, C R" uniqKey="Blagg C" first="C. R." last="Blagg">C. R. Blagg</name><name sortKey="Ing, T" sort="Ing, T" uniqKey="Ing T" first="T." last="Ing">T. Ing</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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