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Lee JS, Lee LP. Microvascular Dynamics and Hemodialysis Response of Patients With End-Stage Renal Disease. Front Bioeng Biotechnol 2022; 10:836990. [PMID: 35662845 PMCID: PMC9159995 DOI: 10.3389/fbioe.2022.836990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
In our previous analysis of three sets of hemodialysis studies, we found that patients possessing higher hematocrit have a higher filtration coefficient KSo and more fluid being restituted from the tissue. A new dynamic analysis is developed to reveal how the plasma protein concentration, restitution volume, and plasma volume are changing over the time course of 240 min hemodialysis. For patients with the filtration coefficient KSo as 0.43 or 5.88 ml/min/mmHg, we find that the restitution rate would reach 50% of the extraction rate in 5.3 or 57.4 min, respectively. By the end of hemodialysis, the restitution rate of both patients asymptotically approaches a value of 0.93 ml/min which is slightly higher than the extraction rate of 9.03 ml/min. The plasma volume drops by 10% of the total plasma volume in 11 min for patients with low KSo and drops by 2.1% and turns around to an increasing trend in 5.6 min for patients with high KSo. These results suggest that the filtration coefficient acts like a facilitator in restituting more fluid from the tissue to compensate for the loss of plasma volume due to extraction. The hematocrit data of three sets of hemodialysis also indicate that significant microvascular blood volume is shifted from small veins toward the venous side of macrocirculation. A better understanding of how the factors examined here cause hypovolemia can be the basis for one to modify the hemodialysis process such that the development of hypovolemia can be avoided over the course of hemodialysis.
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Affiliation(s)
- Jen-Shih Lee
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
- Global Monitors, Inc., San Diego, CA, United States
- *Correspondence: Jen-Shih Lee,
| | - Lian-Pin Lee
- Global Monitors, Inc., San Diego, CA, United States
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Shibamoto T, Cui S, Ruan Z, Liu W, Takano H, Kurata Y. Hepatic venoconstriction is involved in anaphylactic hypotension in rats. Am J Physiol Heart Circ Physiol 2005; 289:H1436-41. [PMID: 15923315 DOI: 10.1152/ajpheart.00368.2005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We determined the roles of liver and splanchnic vascular bed in anaphylactic hypotension in anesthetized rats and the effects of anaphylaxis on hepatic vascular resistances and liver weight in isolated perfused rat livers. In anesthetized rats sensitized with ovalbumin (1 mg), an intravenous injection of 0.6 mg ovalbumin caused not only a decrease in systemic arterial pressure from 120 ± 9 to 43 ± 10 mmHg but also an increase in portal venous pressure that persisted for 20 min after the antigen injection (the portal hypertension phase). The elimination of the splanchnic vascular beds, by the occlusions of the celiac and mesenteric arteries, combined with total hepatectomy attenuated anaphylactic hypotension during the portal hypertension phase. For the isolated perfused rat liver experiment, the livers derived from sensitized rats were hemoperfused via the portal vein at a constant flow. Using the double-occlusion technique to estimate the hepatic sinusoidal pressure, presinusoidal ( Rpre) and postsinusoidal ( Rpost) resistances were calculated. An injection of antigen (0.015 mg) caused venoconstriction characterized by an almost selective increase in Rpre rather than Rpost and liver weight loss. Taken together, these results suggest that liver and splanchnic vascular beds are involved in anaphylactic hypotension presumably because of anaphylactic presinusoidal contraction-induced portal hypertension, which induced splanchnic congestion resulting in a decrease in circulating blood volume and thus systemic arterial hypotension.
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Affiliation(s)
- Toshishige Shibamoto
- Department of Physiology, Kanazawa Medical University, Uchinada Ishikawa 920-0293, Japan.
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