Dialysis-related Factors Research Articles

Role of Dialysis Dose on Morbidity and Mortality in Maintenance Hernodialysis Patients

The United States dialysis population has an excessive mortality rate that cannot be fully explained by comorbid conditions or demographic factors. The quantity of dialysis has been suggested to be insufficient. This report reviews the several dialysis-related factors that impact on mortality. Since the National Cooperative Dialysis Study in 1983, there have been no controlled trials. However, numerous retrospective and two recent larger prospective studies indicate that increasing the quantity of dialysis by 40% to 50% of that traditionally provided in the United States will significantly improve survival. This is equivalent to a Kt/V of less than 1.2 and possibly less than 1.4 using single pool urea kinetics. It is estimated that this would save an additional 8,000 to 16,000 lives per year.

Leukopenia and Hypoxemia

Hemodialysis-induced hypoxemia has been attributed to membrane-related complement activation leading to pulmonary leukostasis and to hypoventilation secondary to carbon dioxide losses via the dialyzer. We have separately assessed the role of membrane- and dialysis-related factors by using different dialyzers and sequential ultrafiltration and hemodialysis with first-use cellulose dialyzers produced both leukopenia and hypoxemia. With reused cellulose and polyacrylonitrile dialyzers, hypoxemia still occurred, but without leukopenia. Ultrafiltration produced leukopenia and no changes in Pao2; during the subsequent hemodialysis, hypoxemia developed as the leukocyte count increased by 50%. Our data indicate that leukopenia and hypoxemia are unrelated effects of hemodialysis, and favor hypoventilation as the major determinant of hypoxemia during hemodialysis.

Leukopenia and hypoxemia. Unrelated effects of hemodialysis

Hemodialysis-induced hypoxemia has been attributed to membrane-related complement activation leading to pulmonary leukostasis and to hypoventilation secondary to carbon dioxide losses via the dialyzer. We have separately assessed the role of membrane- and dialysis-related factors by using different dialyzers and sequential ultrafiltration and hemodialysis. Hemodialysis with first-use cellulose dialyzers produced both leukopenia and hypoxemia. With reused cellulose and polyacrylonitrile dialyzers, hypoxemia still occurred, but without leukopenia. Ultrafiltration produced leukopenia and no changes in Pao₂; during the subsequent hemodialysis, hypoxemia developed as the leukocyte count increased by 50%. Our data indicate that leukopenia and hypoxemia are unrelated effects of hemodialysis, and favor hypoventilation as the major determinant of hypoxemia during hemodialysis. (<i>Arch Intern Med</i>139:1103-1106, 1979)