Advertisement

Hemofiltration pp 201-209 | Cite as

Blood Pressure Control

  • E. A. Quellhorst
Chapter

Abstract

Mechanisms responsible for the maintenance of high blood pressure have been investigated extensively in essential as well as in renovascular hypertension. The pathogenesis of hypertension in end-stage renal failure (ESRF), however, has evidently evoked little interest despite the fact that, due to a diminishing interference of the natural kidneys and an increasing potential allowing a modulation of several factors by the application of an artificial kidney, observations made in patients with advanced renal insufficiency would have been of great value for the elucidation of essential hypertension. Whereas the fractional sodium excretion is increased in mild or moderate renal insufficiency, this compensatory mechanism of the natural kidney is abolished in severe renal failure. Thus, hypertension in patients with renal insufficiency requiring artificial kidney treatment in most cases is a consequence of fluid and sodium overload. In a minor proportion of patients (about 10% of the dialysis population) hypertension may be volume independent, e.g., hypertension continues to exist in spite of adequate fluid removal. Whereas, an inverse relation exists between renin secretion and exchangeable sodium under physiological conditions [1], this individually determined equilibrium may be disturbed in those patients demonstrating an increased renin activity in spite of an augmentation of their exchangeable sodium (Fig.1). Disorders of the autonomic nervous system or catecholamine metabolism seem to be of minor importance, at least as factors for the maintenance of severe hypertension in advanced renal insufficiency.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brown JJ, FraserR, Lever AF, Morton JJ, Robertson JIS, Schalekamp MADH (1977) Mechanisms in hypertension: A personal view. In: Genest J, KoiwE, KuchelO (eds) Hypertension. McGraw-Hill, New York, pp 529–548Google Scholar
  2. 2.
    Quellhorst E, Schuenemann B, Doht B (1977) Treatment of severe hypertension in chronic renal failure by haemofiltration. Proc Eur Dial Transplant Assoc 14: 129–135PubMedGoogle Scholar
  3. 3.
    Baldamus CA, Ernst W, Fassbinder W, Koch KM (1980) Differing haemodynamic stability due to differing sympathetic response: Comparison of ultrafiltration, haemodialysis and haemofil-tration. Proc Eur Dial Transplant Assoc 17: 205–212PubMedGoogle Scholar
  4. 4.
    Quellhorst E, Schuenemann B, Hildebrand U, FaldaZ (1980) Response of the vascular system to different modifications of haemofiltration and haemodialysis. Proc Eur Dial Transplant Assoc 17: 197–203Google Scholar
  5. 5.
    Quellhorst E, Schuenemann B, Hildebrand U (1981) How to prevent vascular instability: Haemofiltration. Proc Eur Dial Transplant Assoc 18: 243–249PubMedGoogle Scholar
  6. 6.
    Quellhorst E, Schuenemann B, Hildebrand U, Neumann W (1982) Hypertension and hemofil- tration. Contrib Nephrol 32: 46–55PubMedGoogle Scholar
  7. 7.
    Henderson LW, Ford CA, Lysaght MJ, Grossman RA, Silverstein ME (1975) Preliminary observations on blood pressure response with maintenance diafiltration. Kidney Int 7: S-413–417CrossRefGoogle Scholar
  8. 8.
    Henderson LW, Sanfelippo ML, Stone RA (1980) Hemofiltration for long-term maintenance of patients with end stage renal disease: Impact on hypertension. Adv Nephrol 9: 21–32Google Scholar
  9. 9.
    Spohr U, Ritz E, Kaden F (1977) Plasma dopamin-ß-hydroxylase-activity in dialysed patients. Klin Wochenschr 55: 1089–1093PubMedCrossRefGoogle Scholar
  10. 10.
    Quellhorst E (1979) Hämofiltration — Differentialindikation zur Hämodialyse unter Berücksichtigung hämodynamischer und metabolischer Aspekte. Klin Wochenschr 57: 1061–1068PubMedCrossRefGoogle Scholar
  11. 11.
    Schneider H, Streicher E, Hövelborn U, Müller HAG, Spohr U, Schmidt-Gayk H (1979) Hae- mofiltration — critical evaluation of clinical benefits. Proc Eur Dial Transplant Assoc 16: 218–223PubMedGoogle Scholar
  12. 12.
    Nakagawa S (1980) Multifactorial evaluation of hemofiltration therapy in comparison with conventional hemodialysis. Artif Organs 4: 94–102PubMedCrossRefGoogle Scholar
  13. 13.
    Baldamus CA, Schoeppe W, Koch KM (1978) Comparison of haemodialysis (HD) and post di¬lution haemofiltration ( HF) on an unselected dialysis population. Proc Eur Dial Transplant Assoc 15: 228–235PubMedGoogle Scholar
  14. 14.
    RoubyJJ, Rottembourg J, DurandeJP, Basset JY, LegrainM (1978) Importance of the plasma refilling rate in the genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration-hemodialysis. Proc Eur Dial Transplant Assoc 15: 239–244PubMedGoogle Scholar
  15. 15.
    Schuenemann B, Borghardt J, FaldaZ, Jacob I, Kramer P, Kraft B, Quellhorst E (1978) Reactions of blood pressure and body spaces to hemofiltration treatment. Trans Am Soc Artif Intern Organs 24: 687–689PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • E. A. Quellhorst

There are no affiliations available

Personalised recommendations