By E.J. Dorhout Mees
Cardiovascular issues aren't in simple terms liable for greater than 1/2 our sufferers' mortality, additionally they characterize the majority of daily difficulties in a dialysis unit. but, the gap allotted to them within the significant textbooks covers purely 2-8% in their overall content material. The origins of this publication lie in lots of years of daily care of dialysis sufferers. It progressively grew to become transparent to the writer that methodical program of recognized pathophysiological rules might increase sufferers' stipulations past expectancies. extra importantly, it seemed that global literature was once as a rule focused on comparing possibility elements and that efforts to enhance analysis have been targeting urea removing. it will be important, as a result, to note that `Volume Control', the primary factor of this ebook, isn't really included into the `Adequacy' inspiration. whereas basically meant for dialysis medical professionals, the writer essentially hopes that dialysis nurses, who hold the lion's percentage of daily accountability for dialysis sufferers, also will locate this booklet an invaluable and functional consultant to dialysis treatment.
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Additional resources for Cardiovascular Aspects of Dialysis Treatment: The importance of volume control
7). 1 Body weight Treatment HD+UF UF HD + UF +C Left atrium diam. mm Blood pressure Ejection fraction % before after before after before after before after 54 53 55 52 51 52 143/98 1841134 19011 00 200/100 42 45 44 38 38 36 28 24 24 40 47 47 160/80 180/100 Data of a patient with 'paradoxical hypertension' before and after three successive treatment sessions. HD = hemodialysis, UF = ultrafiltration, C = 50 mg captopril given immediately before session. Note that atrial diameter decreased and EF increased each time.
This would imply that complete normalization is the ultimate aim. This is supported by the findings of Charra et al. mentioned above. This does not mean that BP should be lowered immediately to normal values in all patients. As will be explained in Chapter 5, it takes time for the body to adapt to a new BP level, particularly when the heart has been damaged. Good clinical judgment is indispensable and therefore close supervision of the patient during this adjustment period is necessary. It should also be remarked that dialysis patients have, for several reasons, a high pulse pressure with elevated systolic pressure while diastolic pressure is often in the 'normal' range.
Note the rapid drop in body weight due to removal of overhydration at the start of treatment, followed by a gradua I rise due to increased dry weight by anabolism. In contrast, blood pressure further decreased during the first six months (from Chazot et al. 1999, with permission). sional additional UF sessions, normotension could be reached in 67 hypertensive patients with only three of them using drugs (Ozkahya et al. 1999). In the beginning hypotensive episodes are frequent, but they disappear once blood pressure has stabilized.