Increased Hepato-Splanchnic Vasoconstriction in Diabetics during Regular HemodialysisReportar como inadecuado




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Background and Objectives

Ultrafiltration UF of excess fluid activates numerous compensatory mechanisms during hemodialysis HD. The increase of both total peripheral and splanchnic vascular resistance is considered essential in maintaining hemodynamic stability. The aim of this study was to evaluate the extent of UF-induced changes in hepato-splanchnic blood flow and resistance in a group of maintenance HD patients during regular dialysis.

Design, Setting, Participants, and Measurements

Hepato-splanchnic flow resistance index RI and hepato-splanchnic perfusion index QI were measured in 12 chronic HD patients using a modified, non-invasive Indocyaningreen ICG dilution method. During a midweek dialysis session we determined RI, QI, ICG disappearance rate kICG, plasma volume Vp, hematocrit Hct, mean arterial blood pressure MAP and heart rate HR at four times in hourly intervals t1 to t4. Dialysis settings were standardized and all patient studies were done in duplicate.

Results

In the whole study group mean UF volume was 1.86 ± 0.46 L, Vp dropped from 3.65 ± 0.77L at t1 to 3.40 ± 0.78L at t4, and all patients remained hemodynamically stable. In all patients RI significantly increased from 12.40 ± 4.21 mmHg∙s∙m2-mL at t1 to 14.94 ± 6.36 mmHg∙s∙m2-mL at t4 while QI significantly decreased from 0.61 ± 0.22 at t1 to 0.52 ± 0.20 L-min-m2 at t4, indicating active vasoconstriction. In diabetic subjects, however, RI was significantly larger than in non-diabetics at all time points. QI was lower in diabetic subjects.

Conclusions

In chronic HD-patients hepato-splanchnic blood flow substantially decreases during moderate UF as a result of an active splanchnic vasoconstriction. Our data indicate that diabetic HD-patients are particularly prone to splanchnic ischemia and might therefore have an increased risk for bacterial translocation, endotoxemia and systemic inflammation.



Autor: Werner Ribitsch , Daniel Schneditz, Casper F. M. Franssen, Gernot Schilcher, Vanessa Stadlbauer, Jörg H. Horina, Alexander R. Ro

Fuente: http://plos.srce.hr/



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