| Theme |
The Choice of Blood Purification for the Patients with Renal Failure |
| Title |
Hemodialysis and pulmonary disease |
| Author |
Shinichi Nishi |
Department of Blood Purification Center, Niigata University |
| Author |
Susumu Hasegawa |
Department of Blood Purification Center, Niigata University |
| Author |
Kyoko Ei |
Santo Clinic |
| Author |
Mizue Oda |
Santo Clinic |
| Author |
Fumitake Gejyo |
Second Department of Internal Medicine, Niigata University |
| [ Summary ] |
There are some pathogenetic factors producing hypoxemia during hemodialysis. In acetate dialysis, the transfer of C02 from the blood to the dialysate causes pulmonary hypoventilation. In bicarbonate dialysis, hypoxemia results from a VQ mismatch, owing to pulmonary vascular permeability, which is induced by leukocytes or complements, activated through contact with the dialysis membrane. It is important for hemodialysis patients with pulmonary diseases to receive bicarbonate dialysis, with the use of high biocompatibility membranes, which can prevent hypoxemia during hemodialysis. Furthermore, it is rccommended to select hemodiafiltration or hemofiltration instead of hemodialysis, because the former methods create a smaller load on the cardio-pulmonary system. |