Biomaterial Database

The relationship between cardiac output and access flow during hemodialysis. 1999

S Pandeya, and R M Lindsay

Optimal Dialysis Research Unit, London Health Sciences Centre, Victoria Campus, Ontario, Canada.

Satisfactory hemodialysis access flow (Qa) is necessary for dialysis adequacy. However, high access flows are postulated to increase cardiac output (CO). The relationship between Qa and CO is not well defined. The purpose of this study was to observe the relationship between Qa and CO and to evaluate the effect of blood volume change (BVdelta) on Qa and CO during hemodialysis (HD). Measurements of Qa and CO (ultrasound dilution; Transonics Monitor, Ithaca, NY) were performed sequentially at baseline in 18 patients (13 forearm arteriovenous fistulae, 5 Gore-Tex grafts) and after an intervention involving either HD with attempted zero BVdelta (mean: -0.4%; range: -2.6 to 1.6%) or a significant BVdelta (mean: -7.3%; range: -3.1 to -11.9%). Measurement of BVdelta was done by hematocrit dilution (Crit-Line Monitor, In-Line Diagnostics, Riverdale, UT). The volume ultrafiltered (V(UF)) and the mean arterial pressure (MAP) were recorded at baseline and after intervention. In five patients with fistulae, CO was measured after manual occlusion of the fistula for 1 min. At baseline, mean (+/-SD) Qa was 1455+/-600 ml/min, and CO was 6.8+/-1.8 L/min. The relationship between Qa and CO was strong, Qa = 0.20 CO + 0.06 (r = 0.62; p = 0.01); this was not significantly altered with either intervention. Access flow was not changed with either zero BVdelta or significant BVdelta. Cardiac output was not altered when there was no BVdelta; however, CO did decrease by 1.2+/-0.6 L/min (p<0.001) after BVdelta reduction. The Qa/CO ratio was unchanged after zero BVdelta but was increased after BVdelta (p = 0.004). There were no correlations with MAP change or V(UF). There were no differences in Qa, CO, or Qa/CO by access type. The mean Qa/CO was 21+/-6%. Three patients had Qa/CO <15%, and they all had access stenoses. Cardiac output did not decrease after transient (1 min) occlusion of the fistula. In conclusion, there is a strong relationship between Qa and CO. With BVdelta, the Qa is maintained while the CO falls and the Qa/CO increases, perhaps by reflex vasoconstriction of the systemic circulation. Longitudinal studies are required to determine which is the dependent variable. A low Qa/CO may indicate access dysfunction.

UI	MeSH Term	Description	Entries
D007676	Kidney Failure, Chronic	The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION.	ESRD,End-Stage Renal Disease,Renal Disease, End-Stage,Renal Failure, Chronic,Renal Failure, End-Stage,Chronic Kidney Failure,End-Stage Kidney Disease,Chronic Renal Failure,Disease, End-Stage Kidney,Disease, End-Stage Renal,End Stage Kidney Disease,End Stage Renal Disease,End-Stage Renal Failure,Kidney Disease, End-Stage,Renal Disease, End Stage,Renal Failure, End Stage
D011237	Predictive Value of Tests	In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.	Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D001783	Blood Flow Velocity	A value equal to the total volume flow divided by the cross-sectional area of the vascular bed.	Blood Flow Velocities,Flow Velocities, Blood,Flow Velocity, Blood,Velocities, Blood Flow,Velocity, Blood Flow
D001794	Blood Pressure	PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS.	Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D001810	Blood Volume	Volume of circulating BLOOD. It is the sum of the PLASMA VOLUME and ERYTHROCYTE VOLUME.	Blood Volumes,Volume, Blood,Volumes, Blood
D002302	Cardiac Output	The volume of BLOOD passing through the HEART per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with STROKE VOLUME (volume per beat).	Cardiac Outputs,Output, Cardiac,Outputs, Cardiac
D003251	Constriction, Pathologic	The condition of an anatomical structure's being constricted beyond normal dimensions.	Stenosis,Stricture,Constriction, Pathological,Pathologic Constriction,Constrictions, Pathologic,Pathologic Constrictions,Pathological Constriction,Stenoses,Strictures
D006400	Hematocrit	The volume of packed RED BLOOD CELLS in a blood specimen. The volume is measured by centrifugation in a tube with graduated markings, or with automated blood cell counters. It is an indicator of erythrocyte status in disease. For example, ANEMIA shows a low value; POLYCYTHEMIA, a high value.	Erythrocyte Volume, Packed,Packed Red-Cell Volume,Erythrocyte Volumes, Packed,Hematocrits,Packed Erythrocyte Volume,Packed Erythrocyte Volumes,Packed Red Cell Volume,Packed Red-Cell Volumes,Red-Cell Volume, Packed,Red-Cell Volumes, Packed,Volume, Packed Erythrocyte,Volume, Packed Red-Cell,Volumes, Packed Erythrocyte,Volumes, Packed Red-Cell
D006435	Renal Dialysis	Therapy for the insufficient cleansing of the BLOOD by the kidneys based on dialysis and including hemodialysis, PERITONEAL DIALYSIS, and HEMODIAFILTRATION.	Dialysis, Extracorporeal,Dialysis, Renal,Extracorporeal Dialysis,Hemodialysis,Dialyses, Extracorporeal,Dialyses, Renal,Extracorporeal Dialyses,Hemodialyses,Renal Dialyses
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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