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KMID : 0367020000120010088
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Journal of Korean Academic of Adult Nursing
2000 Volume.12 No. 1 p.88 ~ p.98
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The Effect of Hypertonic Dialysate on Hemodynamic Parameters(blood pressure, pulse rate, ultrafiltration rate), Interdialytic Weight Gain and the Incidence of Thirst with Hemodialysis Patients
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Kim Mi-Kyung
Park Hye Ja
Chang Eun-Jung
Cho Nam-Mi
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Abstract
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Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group Ⅰ(Conventional HD: sodium concentration: 137 mEq/L), Group Ⅱ(Hypertonic HD: 147 mEq/L) and Group Ⅲ(Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications(interdialytic weight gain & thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group Ⅱ than Group Ⅰ and Ⅲ(p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group Ⅱ and Ⅲ than Group (p=0.04). 2. Incidence of hypotensive episodes during dialysis was significantly lower in Group Ⅱ than Group Ⅰ(p=0.0287). 3. The ultrafiltration in Group Ⅲ at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group Ⅰand Ⅱ at the time of 1 hour, 2 hour and 3 hour check during hemodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group Ⅱ(3.1±0.8) than Group Ⅰ(2.8±0.8) and Ⅲ(2.9±0.9) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group Ⅰ, Ⅱ and Ⅲ, 0.05±0.12, 0.41±0.24 and 0.22±0.29 respectively(p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.
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