Professor of Dialysis & ICI Nephrology.
Consultant Renal Physician, Hon Senior Lecturer, Royal Free Hospital, London.
Membership of European Dialysis & Transplant Association Nutrition committee.
Publications more than 600 original papers/reviews/editorials
More than 50 book chapter
Hemodialysis for the patient with heart failure
Patients with heart failure are at increased risk of hypotension during a hemodialysis session. When patients are connected to the dialysis circuit a number of changes occur. Firstly, there is the reaction between cellular elements in the blood and plasma proteins with the dialyzer. This can activate complement and an inflammatory response, and also generate vasodilators such as bradykinin. These reactions depend upon patient factors, including genotype and phenotype, but also the choice of dialyzer design, biomaterials and surface area, extracorporeal priming fluid and priming procedure, and anticoagulants. Secondly, changes occur in the distribution of blood volume within the body occur during the first few minutes of starting dialysis, with pooling of blood in the central capacitance venous system, and reduction in blood supply to some organs.
This presentation will additionally discuss how to reduce the risk of intra-dialytic hypotension, highlighting the importance of patient education, along with considering the effects of different approaches to ultrafiltration, and the effect of altering the chemical composition and temperature of the dialysate, and the effects of medications.