THE HEMODYNAMIC-EFFECT OF DIFFERENT ULTRAFILTRATION RATES IN PATIENTSWITH CARDIAC-FAILURE AND PATIENTS WITHOUT CARDIAC-FAILURE - COMPARISON BETWEEN ISOLATED ULTRAFILTRATION AND ULTRAFILTRATION WITH DIALYSIS

Objective: The increasing number of dialysis patients with cardiovascu lar diseases will lead to an increase in the incidence of intradialyti c hypotension. Intradialytic hypotension is determined by changes in p lasma volume, changes in vascular reactivity and structural cardiovasc ular changes. In this study the effect of two different ultrafiltratio n rates (UF-rate), i. e. 500 and 1000 ml/h, on plas ma volume, extrace llular volume and arterial blood pressure was studied during different treatments of 2 hours combined ultrafiltration + hemodialysis (UF+HD) and 2 hours isolated ultrafiltration (i-UF). Patients and methods: 15 Patients, 8 patients with cardiac failure, CFpts (NYHA classification III and IV) and 7 patients without cardiac failure (NCFpts) were inve stigated during a standardized dialysis treatment. Results: The decrea se in plasma volume and decrease in extracellular volume was comparabl e both between i-UF and UF+HD and comparable between CFpts and NCFpts and was only dependent on the UP-rate. i-UF resulted in minor blood pr essure changes in both CFpts and NCFpts. In CFpts UF+HD resulted in a significant decrease in systolic blood pressure (SBP) at both UF-rates while in NCFpts SEP decreased significantly only at the higher UF-rat e during UF-HD. Although there were no significant differences in hemo dynamic stability during the different treatment modalities between CF pts and NCFpts, the decrease in SEP in CFpts at the higher UF-rate dur ing UF+HD was much more pronounced. Conclusion: From this clinical stu dy we conclude that differences in hemodynamic stability between i-UF and UF+HD and between CFpts and NCFpts are not related to differences in plasma volume preservation. Other factors like different changes in vascular reactivity and in CFpts structural cardiovascular changes mi ght be responsible for the observed differences.