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What Influences Cardiovascular Instability and Discomfort during Daily Hemodialysis?

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Daily hemodialysis (DHD) markedly ameliorates cardiovascular instability (CVI) and discomfort (DIS) during dialysis, but patients continue to have some of these problems during DHD. We studied what contributed to these problems during 4445 DHD in 23 patients. Methods: 

Dependent variables were increase in pulse rate (PR), maximal (MAX) and overall (OV) fall of systolic blood pressure (BP), and a subjective score of patients' overall evaluation of the quality of dialysis (OEQ), adding a score of 14 symptoms (0 best, 40 worst). Independent variables were ultrapure dialysate and biocompatible dialysis (UP) (1626 dialyses) vs. conventional dialysis (CONV) (2819 dialyses), ultrafiltration (Uf) as percentage of body weight (BW), pre–post BUN (ΔBUN), time on dialysis (T), speed of dialysis (K/V in mL min−1 kg BW−1), and target −post-dialysis BW (Ta-Po BW). Relations were analyzed by backward multiple regression analysis. Results: 

PR increased by 1.6 ± 13/min; MAX BP fall was 25 ± 20 mmHg; OV BP fall was 13 ± 22 mmHg; OEQ = 0.6 ± 1.2. In multiple stepwise backward regression analysis, independents in order of importance: Conclusion: 

To minimize drop in BP and hypotensive crashes, use of ultrapure dialysate and a biocompatible membrane (UP) was by far the most important factor, followed by slowing dialysis. To avoid post-dialysis tachycardia and discomfort during dialysis, slow dialysis was most important. Overall, “fast” dialysis and use of “impure” regular dialysate appear to be the major dialysis factors causing CV instability and discomfort during daily hemodialysis.
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Document Type: Research Article

Affiliations: 1: Aksys Ltd., Lincolnshire, IL 2: University of Missouri, Columbia MO 3: University of Mississippi, Jackson, MS 4: University of Washington, Seattle, WA, U.S.A.

Publication date: 2004-01-01

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