Continuous computerized monitoring of hemodynamic parameters during acetate dialysis, bicarbonate dialysis, and acetate-free biofiltration.

The effects of continuous, computerized, non-invasive hemodynamic monitoring on the appearance of intradialytic symptoms, aided by preventive therapeutic maneuvers, were evaluated in 30 critically ill patients undergoing regular acetate dialysis. The hemodynamic behavior was assessed by a system that interfaces a personal computer with a blood pressure monitor and to a transthoracic electrical impedance-measuring instrument. Monitoring allowed us to reduce significantly the frequency of some important intradialytic symptoms such as nausea, vomiting, and hypotension. The same monitoring system was used acutely to characterize differing hemodynamic behaviors during acetate dialysis (AD), bicarbonate dialysis (BD), and acetate-free biofiltration (AFBF). AD showed a prevalent vasodilation effect with a compensatory increase in heart rate and higher cardiac output values, which were not sufficient to maintain blood pressure stability. BD and AFBF were characterized by a more efficient vasoconstrictor effect and good hemodynamic stability. AFBF, despite a 1 h reduction in session length compared to BD, did not present significant differences in hemodynamic response resulting from session shortness or other technical changes.