Abstract:
BACKGROUND:Intradialytic hypotension (IDH) is a major challenge to safely performing haemodialysis. Blood volume depletion due to fluid removal is a major cause of hypotension, so more emphasis should be placed on finding alternative modalities to traditional constant rate ultrafiltration. SUMMARY:Intermittent back-filtrate infusion haemodiafiltration (I-HDF) utilises purified online quality dialysate with an automated dialysis machine. A bolus of 200 mL of dialysate is repetitively infused at 30-min intervals. A pilot study with 68 hypotension-prone patients revealed that I-HDF can reduce the frequency of IDH interventions, particularly in elderly patients and patients with large interdialytic weight gain (IDWG). This was typically accompanied by an increase in intradialytic blood pressure and decreased tachycardia in the latter half of the session, suggesting reduced sympathetic stimulation during I-HDF. Protective mechanisms involved in the pathophysiology of IDH could be explained in part by the findings obtained in this pilot study. Intermittent increases in blood pressure during I-HDF may prevent venous pooling (i.e., the DeJager-Krogh phenomenon), and reduced sympathetic stimulation may maintain a physiological state less likely to induce the cardio-vagal reflex (i.e., the Bezold-Jarisch reflex). The plasma refilling rate (PRR), evaluated as the refilling fraction (RF), is unexpectedly smaller in I-HDF. However, in patients who respond, the RF is well achieved, which suggests that adequate PRR is the central physiology for preventing IDH. Patients for whom I-HDF is effective are characteristically relatively elderly and show increased IDWG. Blood pressure increment and reduced sympathetic activation in I-HDF may be a mechanism for prevention of IDH. Key Messages: Evaluating relative changes in blood volume during I-HDF will provide a new perspective for exploring appropriate ultrafiltration modification that circumvents IDH.
journal_name
Blood Purifjournal_title
Blood purificationauthors
Koda Y,Aoike Idoi
10.1159/000503878subject
Has Abstractpub_date
2019-01-01 00:00:00pages
1-6eissn
0253-5068issn
1421-9735pii
000503878journal_volume
48 Suppl 1pub_type
杂志文章,评审abstract:BACKGROUND/AIMS:Intravenous iron infusion is the accepted way of supplementation of that compound in uremic patients. The aim of the study was to evaluate whether this treatment affects intraperitoneal homeostasis in patients on peritoneal dialysis. METHODS:Blood and peritoneal dialysate samples were collected from 10...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000210038
更新日期:2009-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000316684
更新日期:2010-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,评审
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更新日期:2008-01-01 00:00:00
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journal_title:Blood purification
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1998-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
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更新日期:2013-01-01 00:00:00
abstract::Acute kidney injury (AKI) is a common complication in pediatric and neonatal intensive care units (ICU). Renal replacement therapy (RRT) is frequently needed in children in whom supportive therapy is not enough to satisfy their metabolic demands or to be able to provide adequate nutrition. The decision to begin dialys...
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pub_type: 杂志文章
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更新日期:2013-01-01 00:00:00
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journal_title:Blood purification
pub_type: 评论,杂志文章
doi:10.1159/000441582
更新日期:2015-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000381006
更新日期:2015-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169604
更新日期:1989-01-01 00:00:00
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pub_type: 社论
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更新日期:2017-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000504245
更新日期:2020-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000489212
更新日期:2018-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,随机对照试验
doi:10.1159/000093680
更新日期:2006-01-01 00:00:00
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journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000494207
更新日期:2019-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000227282
更新日期:2009-01-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1159/000496823
更新日期:2019-01-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1159/000245641
更新日期:2010-01-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1159/000437410
更新日期:2015-01-01 00:00:00
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journal_title:Blood purification
pub_type: 临床试验,杂志文章
doi:10.1159/000088988
更新日期:2005-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,评审
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更新日期:2000-01-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2010-01-01 00:00:00
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更新日期:2017-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2019-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000170201
更新日期:1995-01-01 00:00:00
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journal_title:Blood purification
pub_type:
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更新日期:1993-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,评审
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更新日期:2004-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000170294
更新日期:1996-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000014316
更新日期:1998-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1159/000266483
更新日期:2010-01-01 00:00:00
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journal_title:Blood purification
pub_type: 杂志文章,评审
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更新日期:2004-01-01 00:00:00