Role of osmolality in blood pressure stability after dialysis and ultrafiltration

W. L. Henrich, T. D. Woodard, J. D. Blachley, C. Gomez-Sanchez, W. Pettinger, R. E. Cronin

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

To clarify the mechanisms involved in the stability of blood pressure during ultrafiltration (UF) alone versus regular dialysis, this study systematically examined the importance of changes in serum potassium, osmolality, and plasma norepinephrine during several dialysis maneuvers. Six stable, normotensive chronic dialysis patients were subjected to a uniform 2 to 3% decrease in body weight during the 2 hours of each dialysis maneuver. Supine to upright mean blood pressure (MBP) decreased (90 to 75 mm Hg, P <0.05), and three patients became symptomatic after weight loss during regular dialysis, but orthostatic blood pressure was stable (89 to 86 mm Hg, NS) and the patients were asymptomatic after UF and weight loss. Isokalemic regular dialysis did not afford hemodynamic stability, as orthostatic MBP declined (85 to 56 mm Hg, P <0.02), and four of the patients again were symptomatic after standing. A continuous hypertonic mannitol (25%) infusion during the 2-hour dialysis, however, kept osmolality from decreasing and was associated with a stable orthostatic MBP (89 to 83 mm Hg, NS). A continuous infusion of isotonic mannitol (5%) given in a volume five times that of the hypertonic mannitol failed to prevent orthostatic hypotension (89 to 60 mm Hg, P <0.005). Plasma norepinephrine concentrations were high in these patients and increased only modestly after weight loss. These results implicate constant plasma osmolality as a critical protective factor of blood pressure during UF and further demonstrate that changes in blood pressure may be dissociated from changes in both serum potassium and plasma norepinephrine concentration.

Original languageEnglish (US)
Pages (from-to)480-488
Number of pages9
JournalKidney International
Volume18
Issue number4
StatePublished - 1980

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Ultrafiltration
Osmolar Concentration
Dialysis
Blood Pressure
Mannitol
Weight Loss
Norepinephrine
Potassium
Orthostatic Hypotension
Serum
Hemodynamics
Body Weight

ASJC Scopus subject areas

  • Nephrology

Cite this

Henrich, W. L., Woodard, T. D., Blachley, J. D., Gomez-Sanchez, C., Pettinger, W., & Cronin, R. E. (1980). Role of osmolality in blood pressure stability after dialysis and ultrafiltration. Kidney International, 18(4), 480-488.

Role of osmolality in blood pressure stability after dialysis and ultrafiltration. / Henrich, W. L.; Woodard, T. D.; Blachley, J. D.; Gomez-Sanchez, C.; Pettinger, W.; Cronin, R. E.

In: Kidney International, Vol. 18, No. 4, 1980, p. 480-488.

Research output: Contribution to journalArticle

Henrich, WL, Woodard, TD, Blachley, JD, Gomez-Sanchez, C, Pettinger, W & Cronin, RE 1980, 'Role of osmolality in blood pressure stability after dialysis and ultrafiltration', Kidney International, vol. 18, no. 4, pp. 480-488.
Henrich WL, Woodard TD, Blachley JD, Gomez-Sanchez C, Pettinger W, Cronin RE. Role of osmolality in blood pressure stability after dialysis and ultrafiltration. Kidney International. 1980;18(4):480-488.
Henrich, W. L. ; Woodard, T. D. ; Blachley, J. D. ; Gomez-Sanchez, C. ; Pettinger, W. ; Cronin, R. E. / Role of osmolality in blood pressure stability after dialysis and ultrafiltration. In: Kidney International. 1980 ; Vol. 18, No. 4. pp. 480-488.
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