Abstract
Hemodynamic effects of isovolumetric hemodialysis (HD) were studied in 6 patients using two different dialysates; acetate and bicarbonate. For each HD, hemodynamic parameters were measured hourly by the use of Swan-Ganz thermodilution catheter. During acetate HD, significant reduction in both systemic vascular resistance (SVR) and mean arterial pressure (AP) was observed. Cardiac output (CO) was increased mildly with the resultant reduction in pulmonary capillary wedge pressure (PCWP). During bicarbonate HD, however, these parameters showed little changes. The effects of catecholamines (noradrenaline (NA) and dopamine (DOP)) on the hemodynamic changes during acetate HD were also investigated. NA infused at the rate of 0.20-0.24μg/kg/min increased SVR toward control level and restored AP. CO, PCWP, and HR were affected insignificantly by the intervention. For the SVR and AP restoration equivalent to those with NA, required DOP dose was 15-20μg/kg/min which produced a significant increase in HR. We conclude that: (1) for the patients who show cardiovascular instability during HD, bicarbonate HD appears more feasible than acetate HD; (2) fall in SVR and AP during acetate HD could be treated more effectively with NA than with DOP.
