By E.J. Dorhout Mees
Cardiovascular issues will not be basically accountable for greater than 1/2 our sufferers' mortality, in addition they characterize the majority of daily difficulties in a dialysis unit. but, the distance allotted to them within the significant textbooks covers purely 2-8% in their overall content material. The origins of this booklet lie in lots of years of day by day care of dialysis sufferers. It steadily grew to become transparent to the writer that methodical program of famous pathophysiological rules may possibly enhance sufferers' stipulations past expectancies. extra importantly, it seemed that global literature was once ordinarily interested in comparing chance elements and that efforts to enhance diagnosis have been targeting urea elimination. it is necessary, consequently, to note that `Volume Control', the significant factor of this e-book, isn't integrated into the `Adequacy' notion. whereas essentially meant for dialysis medical professionals, the writer truly hopes that dialysis nurses, who hold the lion's percentage of day by day accountability for dialysis sufferers, also will locate this publication an invaluable and useful advisor to dialysis treatment.
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Extra info for Cardiovascular Aspects of Dialysis Treatment: The importance of volume control
3). 45 160 a.. ) A B 40 •• 30 ~ !!...... iij Cl 20 a.. 3 A: Relation between interdialytic volume gain and increase in blood pressure (BP). B: No such relationship in drug-treated patients (from Ventura et al. 1997, with permission). the estimates by the authors on the pathogenic role of volume retention. The curvilinear relationship and the time factor can easily explain apparent contradictions in the literature, in particular the absence of a clear relationship between BP and short-time weight changes reported by some, but not by others.
Strong vasodilators are another option, and Minoxidil has been advocated in patients with refractory hypertension. However, in patients with essential 46 HYPERTENSION IN DIALYSIS PATIENTS hypertension it was shown to increase cardiac volume, muscle mass and ultimately morbidity (Leenen et al. 1990). Converting enzyme inhibitors (CEls) and angiotensin II antagonists are a logical choice for patients who are resistant to volume correction and probably have high plasma renin activity. Moreover CEls also decrease sympathetic nerve discharge and have a favorable action on arterial and myocardial hypertrophy.
With respiration, the pressure and thus the diameter in the vena cava change. The fractional decrease in diameter on inspiration is called the 'collaps index'. With hypervolemia pressure remains 1 During dialysis, Na will diffuse to the blood and the amount to be ultrafiltrated will yet have to match the increase in body weight. 24 RESULTS OF FLUID RETENTION high and the collapse index remains close to 1. With hypovolemia it may completely collapse during inspiration. 6. Both diameter and collapse index correlate with right atrial pressure.