NDT Advance Access originally published online on January 31, 2006
Nephrology Dialysis Transplantation 2006 21(5):1305-1311; doi:10.1093/ndt/gfk070
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Norepinephrine-induced vasoconstriction results in decreased blood volume in dialysis patients
1 Department of Internal Medicine, 2 Department of Cardiology and 3 Department of Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
Correspondence and offprint requests to: Robert Zietse, MD, Erasmus MC, Department of Internal Medicine, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Email: r.zietse{at}erasmusmc.nl
Background. Hypotension during haemodialysis results from an inadequate cardiovascular response to ultrafiltration-induced hypovolaemia. It has been suggested that plasma volume could be increased as a result of systemic vasoconstriction.
Methods. We studied the effect of a norepinephrine (NOR) infusion (30 min), compared with no infusion, on relative blood volume (RBV) in six haemodialysis patients. During infusion we measured RBV, systolic blood pressure (SAP), heart rate (HR), stroke volume index (SI), total peripheral resistance (TPRI), ejection fraction (EF), inferior vena cava diameter (VCD) and core temperature.
Results. At the end of the NOR infusion, we observed a significant increase in TPRI (47±47% vs 4±17%; P<0.01) and SAP (27±12% vs 0±8%; P<0.01). Norepinephrine-induced vasoconstriction resulted in a significant decrease in RBV (–9±3% vs 0±1%; P<0.01). No significant changes were seen in SI (–4±21% vs 0±8%), HR (–5±19% vs –4±5%), EF (7±14% vs –2±10%), VCD or temperature.
Conclusions. We conclude that norepinephrine-induced vasoconstriction results in a decrease in RBV. This indicates that improved haemodynamic stability during haemodialysis through vasoconstriction can be accompanied by a decrease in RBV and that part of the variability in blood volume may be due to changes in arterial tone. Such changes must be taken into account if RBV measurements are used to improve the haemodynamic tolerance of dialysis.
Keywords: blood volume monitoring; haemodialysis; relative blood volume; vasoconstriction
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