ABSTRACT
Anemia correction by erythropoietin favorably affects dialysis outcome but may also reduce dialysis efficiency increasing morbidity and mortality. Single needle dialysis (SN) and high dialysate flow (DF) are dialysis variations. We studied the effect of hemoglobin (Hb) normalization on dialysis adequacy under high DF. We also compared double needle (DN) and SN dialysis efficiency. Seventeen stable anuric patients (13 M, 4 F), aged 62 (40-90), on hemodialysis for 48 months (8-204), were studied in two, 6 months apart, periods of low (A) and high Hb (B), during a midweek 4 h dialysis with DN and SN. DF was 500 in A and 800 ml/min in B. Rebound urea samples, 20 min post dialysis, were used for computer calculated double pool urea kinetics. Hb levels were 128 +/- 8 g/L (B) vs. 119 +/- 14 g/L (A), P < 0.03. Despite the use of higher DF less dialysis was delivered in B vs. A, under DN or SN (DN: URR 64.8 +/- 5.8 vs. 69.7 +/- 5.2%, Kt/Vequil. 1.09 +/- 0.19 vs. 1.26 +/- 0.21, nPCR 1.37 +/- 0.29 vs. 1.60 +/- 0.36g/kg/day, changes <0.001, SN: URR 49.7 +/- 7.5% vs. 52.6 +/- 8.8%, Kt/Vequil. 0.74 +/- 0.16 vs. 0.82 +/- 0.23, nPCR 1.05 +/- 0.33 vs. 1.20 +/- 0.31, changes NS). SN was found significantly (P < 0.001) less efficient than DN in A and B. Serum creatinine drop was significantly (P < 0.001) less in both periods with SN vs. DN. Hb (SN in B) correlated inversely to Kt/V (r = -0.5705, P < 0.02) and URR (r = -0.6432, P = 0.005). Hb correction to normality is associated with a decrease in dialysis efficiency. The use of high dialysate flow does not compensate for this loss. SN delivers inadequate dialysis independently of dialysate flow or hemoglobin concentration.
Subject(s)
Hemoglobins/analysis , Needles , Renal Dialysis/methods , Adult , Aged , Aged, 80 and over , Anemia/etiology , Anemia/therapy , Creatinine/blood , Female , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , Treatment Outcome , Urea/metabolismABSTRACT
Hypertension in dialysis patients is considered a major factor in cardiovascular mortality. We investigated long-term efficacy of intermittent atenolol (AT) administration in 10 (7M/3F) hypertensive dialysis patients, age 60.5 (38-72), on dialysis for 56.5 months (8-156) thrice per week (10.5-13.5 h/w) (A). A similar group of 11 normotensive patients served as controls (B). Hypertension was defined as BP> 140/90 (day) and >120/80 mmHg (night) by a 44-h ambulatory BP monitoring (ABPM) after the mid-week session. Dialysis ultrafiltration, hematology, biochemistry were similar in A and B. Atenolol was started on an alternate day, 37.5 mg/w and increased as needed. After 34 days (6-80) and a dose of 68.75 (37.5-450) mg/w, BP dropped (ABPM: MAP 104+/-11.5 to 95.6+/-10.4 mmHg, P=0.0025) similar to controls and daytime HR dropped: 84.6+/-9.2 to 69.3+/-8.2, P=0.0008 and at night: 79.5+/-7.6 to 68.6+/-8.6 b/1' becoming lower than in B: 83+/-10.8/69.3+/-8.2, P=0.009 and 80.5+/-11.7/68.6+/-8.6 b/1' (P=0. 02). Six months later ABPM in A as well as echocardiography in A and B remained unchanged. Moderate, volume independent hypertension in stable dialysis patients is easily controlled during the interdialytic period by small intermittent atenolol doses.
