Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients
Introduction Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, i...
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| Veröffentlicht in: | Hemodialysis international 2024-07, Vol.28 (3), p.290-303 |
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| creator | Jensen, Jonas Schandorph Kaalund Jørgensen, Ina Hunnerup Buus, Niels Henrik Jensen, Jens Dam Peters, Christian Daugaard |
| description | Introduction
Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes.
Methods
Fifteen hemodialysis patients were examined in a single‐blind, randomized, controlled, crossover study. Participants underwent a 4‐h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre‐ and post‐hemodialysis.
Findings
With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post‐hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly.
Discussion
The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate. |
| doi_str_mv | 10.1111/hdi.13162 |
| format | Article |
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Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes.
Methods
Fifteen hemodialysis patients were examined in a single‐blind, randomized, controlled, crossover study. Participants underwent a 4‐h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre‐ and post‐hemodialysis.
Findings
With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post‐hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly.
Discussion
The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate.</description><identifier>ISSN: 1492-7535</identifier><identifier>ISSN: 1542-4758</identifier><identifier>EISSN: 1542-4758</identifier><identifier>DOI: 10.1111/hdi.13162</identifier><identifier>PMID: 38803230</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adult ; Aged ; bicarbonate ; Bicarbonates - pharmacology ; blood pressure ; Blood Pressure - drug effects ; chronic renal failure ; Cross-Over Studies ; dialysate solutions ; dialysis ; Dialysis Solutions - administration & dosage ; Dialysis Solutions - pharmacology ; Female ; hemodialysis solutions ; Hemodynamics - drug effects ; Humans ; Kidney Failure, Chronic - therapy ; Male ; Middle Aged ; Renal Dialysis - adverse effects ; Renal Dialysis - methods ; Single-Blind Method</subject><ispartof>Hemodialysis international, 2024-07, Vol.28 (3), p.290-303</ispartof><rights>2024 The Author(s). published by Wiley Periodicals LLC on behalf of International Society for Hemodialysis.</rights><rights>2024 The Author(s). Hemodialysis International published by Wiley Periodicals LLC on behalf of International Society for Hemodialysis.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2502-e43196c03201b8164674ddf559376cfdaa91502450d2e5dca6c7f08a34640d593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhdi.13162$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhdi.13162$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38803230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jensen, Jonas Schandorph Kaalund</creatorcontrib><creatorcontrib>Jørgensen, Ina Hunnerup</creatorcontrib><creatorcontrib>Buus, Niels Henrik</creatorcontrib><creatorcontrib>Jensen, Jens Dam</creatorcontrib><creatorcontrib>Peters, Christian Daugaard</creatorcontrib><title>Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients</title><title>Hemodialysis international</title><addtitle>Hemodial Int</addtitle><description>Introduction
Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes.
Methods
Fifteen hemodialysis patients were examined in a single‐blind, randomized, controlled, crossover study. Participants underwent a 4‐h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre‐ and post‐hemodialysis.
Findings
With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post‐hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly.
Discussion
The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate.</description><subject>Adult</subject><subject>Aged</subject><subject>bicarbonate</subject><subject>Bicarbonates - pharmacology</subject><subject>blood pressure</subject><subject>Blood Pressure - drug effects</subject><subject>chronic renal failure</subject><subject>Cross-Over Studies</subject><subject>dialysate solutions</subject><subject>dialysis</subject><subject>Dialysis Solutions - administration & dosage</subject><subject>Dialysis Solutions - pharmacology</subject><subject>Female</subject><subject>hemodialysis solutions</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Renal Dialysis - adverse effects</subject><subject>Renal Dialysis - methods</subject><subject>Single-Blind Method</subject><issn>1492-7535</issn><issn>1542-4758</issn><issn>1542-4758</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAQhi0EoqUw8AeQRxjS2vFH0hGVjyJVYoHZcmyHGCVxsROq_HvcprBxy53uHj06vQBcYzTHsRaVtnNMME9PwBQzmiY0Y_lpnOkyTTJG2ARchPCJUIoR4udgQvIckZSgKVBr0zg9tLKxCpqyNKoL0JWwdjv4bXzoA6zsRwW1lfUQZGdgYZX0hWv3s3KtMm3nZWddC20Lq73tgNoAt3Edr-ESnJWyDubq2Gfg_enxbbVONq_PL6v7TaJShtLEUIKXXMXHEC5yzCnPqNYlY0uScVVqKZc4cpQhnRqmleQqK1EuCeUU6UjNwO3o3Xr31ZvQicYGZepatsb1QRDEMSY8SiJ6N6LKuxC8KcXW20b6QWAk9pmKmKk4ZBrZm6O2Lxqj_8jfECOwGIGdrc3wv0msH15G5Q_PAYDj</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Jensen, Jonas Schandorph Kaalund</creator><creator>Jørgensen, Ina Hunnerup</creator><creator>Buus, Niels Henrik</creator><creator>Jensen, Jens Dam</creator><creator>Peters, Christian Daugaard</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202407</creationdate><title>Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients</title><author>Jensen, Jonas Schandorph Kaalund ; Jørgensen, Ina Hunnerup ; Buus, Niels Henrik ; Jensen, Jens Dam ; Peters, Christian Daugaard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2502-e43196c03201b8164674ddf559376cfdaa91502450d2e5dca6c7f08a34640d593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>bicarbonate</topic><topic>Bicarbonates - pharmacology</topic><topic>blood pressure</topic><topic>Blood Pressure - drug effects</topic><topic>chronic renal failure</topic><topic>Cross-Over Studies</topic><topic>dialysate solutions</topic><topic>dialysis</topic><topic>Dialysis Solutions - administration & dosage</topic><topic>Dialysis Solutions - pharmacology</topic><topic>Female</topic><topic>hemodialysis solutions</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Renal Dialysis - adverse effects</topic><topic>Renal Dialysis - methods</topic><topic>Single-Blind Method</topic><toplevel>online_resources</toplevel><creatorcontrib>Jensen, Jonas Schandorph Kaalund</creatorcontrib><creatorcontrib>Jørgensen, Ina Hunnerup</creatorcontrib><creatorcontrib>Buus, Niels Henrik</creatorcontrib><creatorcontrib>Jensen, Jens Dam</creatorcontrib><creatorcontrib>Peters, Christian Daugaard</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Hemodialysis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jensen, Jonas Schandorph Kaalund</au><au>Jørgensen, Ina Hunnerup</au><au>Buus, Niels Henrik</au><au>Jensen, Jens Dam</au><au>Peters, Christian Daugaard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients</atitle><jtitle>Hemodialysis international</jtitle><addtitle>Hemodial Int</addtitle><date>2024-07</date><risdate>2024</risdate><volume>28</volume><issue>3</issue><spage>290</spage><epage>303</epage><pages>290-303</pages><issn>1492-7535</issn><issn>1542-4758</issn><eissn>1542-4758</eissn><abstract>Introduction
Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes.
Methods
Fifteen hemodialysis patients were examined in a single‐blind, randomized, controlled, crossover study. Participants underwent a 4‐h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre‐ and post‐hemodialysis.
Findings
With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post‐hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly.
Discussion
The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>38803230</pmid><doi>10.1111/hdi.13162</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged bicarbonate Bicarbonates - pharmacology blood pressure Blood Pressure - drug effects chronic renal failure Cross-Over Studies dialysate solutions dialysis Dialysis Solutions - administration & dosage Dialysis Solutions - pharmacology Female hemodialysis solutions Hemodynamics - drug effects Humans Kidney Failure, Chronic - therapy Male Middle Aged Renal Dialysis - adverse effects Renal Dialysis - methods Single-Blind Method |
| title | Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients |
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