Microcirculation During Haemodialysis

Overview

* SDF is validated by measuring changes in microcirculation in sepsis patients with MOF (Boerma studies). * SDF is validated by measuring changes in microcirculation in stable chronic hemodialysis patients (NDT 2009 Bemelmans). * Ultrafiltration in stable chronic hemodialysis leads to a decrease in sublingual microcirculatory flow (NDT 2009 Bemelmans). * Trendelenburg position improves the sublingual microcirculatory flow at the end of hemodialysis treatment (NDT 2009 Bemelmans). * Hemodialysis with ultrafiltration leads to a significant reduction of myocardial perfusion and cardiac output (NDT 2009 Dasselaar) * Cardiac output measurement during dialysis is not practical. * BVM is a validated method for hypotension due to ultrafiltration to prevent the amount of ultrafiltration online change based on the measured haemoconcentration (ref Dasselaar et al NDT 2005). * BCM is a validated measurement to the dry weight in hemodialysis patients measured by a bioimpedance technique (NDT Passauer et al 2009).

The search for an optimal method of ultrafiltration with minimal hypoperfusion of vital organs. * Stabile hemodialysis patients with dialysis dependancy for more than 3 months, with adequate access * Study duration 3 weeks * Number of hemodialysis treatment for purposes of study: 3 * Timing hemodialysis treatments for Study session Monday or Tuesday after the weekend (randomized design in the sessions) * session a: 5 hours total duration: 4 hours HD without UF followed by 1 hour GUF * Session b: 4 hours total duration: 4 hours HD with UF * session c: 4 hours total duration: 4 hours HD with UF and BVM * UF is determined by actual target weight. * Measurements during sessions: * In each session in advance: blood pressure, pulse, weight, BCM, laboratory tests (Hb, Hct, Na, K, urea, creatinine, calcium, albumin, phosphate, nt-proBNP, troponin T, CRP) * During each session at t = 0, t = 1 hour, t =2 hours and t = 4 hours: SDF, blood pressure, pulse, UF at that time, UF rate at that time * End each session: blood pressure, pulse, weight, BCM, laboratory tests (Hb, Hct, Na, K, urea, creatinine, calcium, albumin, phosphate, nt-proBNP, troponin T, CRP)

Conditions