Abstract
Changes in blood pressure (Bp) during hemodialysis (HD) was studied in 107 dialysis patients and they were divided into three groups on the basis of blood pressure response for ultrafiltration by hemodialysis,
Group 1: 4 patients (3.7%), Bp increased during HD.
Group 2: 79 patients (73.9%) Bp stable during HD.
Group 3: 24 patients (22.4%), Bp decreased during HD.
From technical aspect, Swan-Ganz thermodilution catheter was inserted into the femoral vein before HD and hemodynamic change during single HD was observed.
As a result, diastolic pressure of pulmonary artery (PAd) and mean right atrial pressure (RA), which were closely related to preload, were decreased in all three groups and same change in cardiac index (CI) was obtained. Although CI was decreased, Bp was increased due to elevation in total systemic peripheral resistance (TSPR) in Group 1 and was decreased in the absence of compensated elevation of TSPR in Group 3. Three of the four patients in Group 1 were chronic renal failure secondary to malignant hypertension with persistent high plasma resin activity. In conclusion, change in TSPR appears to be a critical factor of the blood pressure response during hemodialysis.
