Cardiopulmonary events during hemodialysis: Effects of dialysis membranes and dialysate buffers

Adverse cardiac and pulmonary events are frequently observed during hemodia lysis and contribute to significant morbidity and mortality. The temporal r elationship between these events during the intradialytic period has not be en well defined. To examine the event rate and timing of silent ischemia, c ardiac ectopy, and hypoxemia, we conducted a prospective, single-blind, ran domized study of 10 subjects undergoing maintenance hemodialysis with four contiguous combinations of dialysis membranes (cuprammonium or polysulfone) and dialysates (acetate or bicarbonate). The frequency of oxygen desaturat ion events peaked during the first 2 hours, whereas silent myocardial ische mia and supraventricular ectopies occurred more often in the later hours. V entricular ectopy occurred steadily throughout the intradialytic period. Th e combination of acetate dialysis and cuprammonium membrane is associated w ith the most frequent events. We conclude that cardiopulmonary events can o ccur frequently during hemodialysis, and the frequency is dependent on the type of dialysis membrane and dialysate buffer used. (C) 2000 by the Nation al Kidney Foundation, Inc.