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Haemodynamics in Dialysis Hypotension and the Possible Role of Splanchnic Circulation



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Haemodynamics in Dialysis Hypotension and the Possible Role of Splanchnic Circulation by Wai-Yin Alex Yu
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This dissertation, "Haemodynamics in Dialysis Hypotension and the Possible Role of Splanchnic Circulation" by Wai-yin, Alex, Yu, 余惠賢, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Abstract of the thesis entitled HAEMODYNAMICS IN DIALYSIS HYPOTENSION AND THE POSSIBLE ROLE OF SPLANCHNIC CIRCULATION submitted by Yu Wai Yin, Alex for the degree of Doctor of Medicine at the University of Hong Kong in June 2005 The haemodynamic causes of hypotension during haemodialysis are multifactorial but the reduction of blood volume is pivotal. Hypotension during haemodialysis ultimately reflects a decrease in cardiac output beyond the point that can be compensated for by increased peripheral resistance or a decrease in vascular resistance beyond the point to which increased cardiac output is able to compensate. These two mechanisms may be involved in a dynamic balance during the course of a dialysis session. In this series of studies, we examined the haemodynamic changes with use of acetate-based haemodialysis, use of "cool" dialysate, food ingestion during hemodialysis, and their possible association with dialysis-associated hypotension. Finally the role of the splanchnic and splenic circulations in the preservation of MAP (mean arterial pressure) during haemodialysis was studied. Changes in cardiac output during haemodialysis were determined by measuring changes in thoracic electrical bioimpedance. In haemodialysis using iiacetate-based dialysate, a marked (22%) increase in cardiac output was seen concurrent with a moderate fall in blood pressure and total peripheral resistance. In contrast, when lactate- or bicarbonate-based dialysate was used, the patient's blood pressure, cardiac output, and total peripheral resistance were less affected. Food ingestion during dialysis led to a hypotensive effect, possibly caused by a fall in systemic vascular resistance. Blood pressure decreased sooner and to a greater extent in study patients who ingested food while undergoing ultrafiltration compared to those who ate nothing. In these subjects, their cardiac index was well maintained and increased after food ingestion. A lower core body temperature might also account for more stable blood pressure. In our study, patients were dialysed with cool dialysate. A significantly higher MAP was observed in those patients who received cool dialysate. Cardiac output was found to make no significant contribution to the maintenance of arterial pressure. Higher MAP was found to be due primarily to changes in total peripheral resistance. The contribution of the splanchnic/splenic circulations to the haemodynamic changes observed in patients undergoing haemodialysis were 99m determined by tagging the patients' erythrocytes with technetium and recording changes in abdominal radioactivity over time. Splanchnic erythrocyte radioactivity decreased by about 10% during isolated ultrafiltration and during which arterial pressure was preserved. The presence of intact ANS function appears to be necessary for the preservation of MAP under conditions of fluid removal. In a patient with impaired autonomic nervous system function, no decrease in either splanchnic or splenic radioactivity is seen during fluid removal despite a fall in MAP. iiiThe findings of our study elucidate some of the factors underlying haemodynamic stability during haemodialysis. The splanchnic circulation and an intact autonomic nervous system appear to play a role in addition to the observed changes in cardiac output and total peripheral resistance. The interact
Release date NZ
January 27th, 2017
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Country of Publication
United States
colour illustrations
Open Dissertation Press
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