Blood Flow,Negative Pressure,and Hemolysis During Hemodialysis

Blood flow, measured by an ultrasound flowmeter, and the extent of hemolysis were assessed during a single, routine dialysis in 100 patients. Before and after the hemodialysis session, blood was drawn for measurements of haptoglobin (HPT), hemoglobin (HGB), albumin (ALB), and lactate dehydrogenase (LDH). The average values were as follows: pump speed 510 mL/ min, real blood flow 422 mL/min, arterial chamber pressure -350 mm Hg, and venous chamber pressure 279 mm Hg. Haptoglobin concentrations were higher in patients with central vein catheters compared to patients with arteriovenous access. The meaning of this finding is unclear. Mean HPT concentrations increased significantly less during hemodialysis (2.37%) than concentrations of ALB (11.3%), HGB (9.17%), and LDH (18.2%), indicating that some hemolysis is present in all dialyses. In dialyses with arterial chamber pressures more negative than -350 the median concentration of ALB (8.70%) increased significantly more than the median concentration of HGB (7.99%). This indicates significantly more hemolysis in dialyses with more negative pressures compared to those with less negative arterial chamber pressures. Median LDH increased more in dialyses with more negative prepump chamber pressures (16.19% vs 13.78%), but not significantly; however, LDH increases were significantly higher than either HGB or ALB, thus indicating significantly more hemolysis in dialyses with more negative pressures compared to those with less negative arterial chamber pressures. Erythropoietin dose was not significantly different in patients dialyzed with more or less negative arterial chamber pressures (17 645 ± 1226 U/week vs 16 308 ± 1506 U/week). We conclude that dialyses with negative arterial chamber pressures greater than -350 mm Hg cause slightly higher hemolysis than dialyses with less negative arterial chamber pressures, but this increased hemolysis is not associated with an increased requirement of erythropoietin dose. Whether this increased hemolysis is of clinical significance is uncertain.