Interstitial correction of blood volume decrease during hemodialysis.

The etiology of hypotension during hemodialysis is multifactorial. Probably a decrease in blood volume caused by ultrafiltration, and acetate are both involved, while refilling from the interstitium acts as a compensatory mechanism. An osmotically induced transcellular fluid shift to intracellular might reduce the refilling capacity. This study investigated the effect of ultrafiltration on blood volume, blood pressure and refilling. The role of acetate and blood volume decrease in hypotension was established and intra- and extracellular fluid changes were calculated. Blood volume decrease depended on ultrafiltration: at high ultrafiltration rates refilling failed, apparently more so at high acetate plasma levels. An isolated blood volume decrease did not lower blood pressure. Concomitant high acetate levels caused hypotension and also seemed to reduce refilling. Nearly all refilling fluid came from the extracellular compartment. Only high dialysate sodium concentrations gave rise to an intracellular loss.