Abstract
CVI is the most dangerous complication of dialysis. We studied factors influencing CVI, as 23 patients switched from conventional purity DHD (ConD) (N=861) to ultrapure DHD - the Aksys PHD system (N=670). Dependent factors: Pre - post systolic BP (Syst), pre-post diastolic BP (Diast) and post - pre dialysis pulse rate (PR). Independent factors: Purity of dialysis - either ConD or ultrapure (40 liter rinse, endotoxin and Silk Worm Larvae Plasma test negative dialysate, no first use or PVC) -, the rapidity of clearance as K/V ml/min/kg (KV) as a measure of osmolality fall, ultrafiltration rate (% UF/BW) and over- ultrafiltration (post - target weight in kg) (P/T). Syst = 13 ± 22. Diast = 5 ± 12. PR = 2 ± 13. The data were analyzed in multiple backward stepwise analysis. Syst = ConD × 12 + UFx4-P/T × 5-3. R= 0.33, p <0.0001 Diast = ConD × 5 + UF × 1-2. R = 0.22, p <0.0001 PR = KV × 1 + P/T × 1 - 3 R= 0.12, p = 0.0001 For blood pressure stability during dialysis, ultrapure dialysis is more important than ultrafiltration or osmolality change speed or ultrafiltration accuracy. To avoidtachycardia, slowing dialysis is most important followed by ultrafiltration accuracy. Purity of the whole dialysis system, not just the dialysate or biocompatiblity of membrane, appears to be a major dialysis factor in avoiding cardio-vascular instability during dialysis.
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