{"id":1234,"date":"2020-03-26T04:30:58","date_gmt":"2020-03-26T04:30:58","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=1234"},"modified":"2025-05-09T16:09:31","modified_gmt":"2025-05-09T21:09:31","slug":"hypoxia","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/hypoxia\/","title":{"rendered":"Hypoxia"},"content":{"rendered":"<p>During hemodialysis, PaO<sub>2<\/sub>\u00a0falls about 10-20 mmHg. This decrease has no clinical consequences in patients with normal oxygen tension, but in seriously ill patients with predialysis hypoxemia, the drop in PaO<sub>2<\/sub>\u00a0can be catastrophic.<\/p>\n<h4>Etiology<\/h4>\n<ul>\n<li>Acetate dialysate (now obsolete).\u00a0 Can also be seen with use of bicarbonate dialysate<\/li>\n<li>Acetate causes hypoxemia by at least two mechanisms:\n<ul>\n<li>Increased oxygen consumption in the metabolism of acetate to bicarbonate<\/li>\n<li>Intradialytic loss of CO<sub>2<\/sub><\/li>\n<\/ul>\n<\/li>\n<li>Rapid correction of chronic metabolic acidosis<\/li>\n<li>Bioincompatible membranes\n<ul>\n<li>Activate complement<sup>1<\/sup><\/li>\n<\/ul>\n<\/li>\n<li>Hypocapnea due to intradialytic loss of CO<sub>2<\/sub>\u00a0and adaptation to chronic metabolic acidosis predisposes to periodic breathing and sleep apnea syndrome (SAS)<sup>1<\/sup><\/li>\n<li>SAS is also a cause of hypoxia in HD patients<sup>2<\/sup>\n<ul>\n<li>High prevalence in HD patients (54-80%) and has both obstructive and central components<\/li>\n<li>Can alter autonomic responses and cause arrhythmias, pulmonary hypertension, and systemic hypertension<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4>Treatment and Prevention<\/h4>\n<ul>\n<li>Dialysis-induced hypoxemia can be attenuated by interventions that increase the CO<sub>2<\/sub>\u00a0content of the dialysate either by direct administration or by using bicarbonate buffered dialysate<\/li>\n<li>Use of biocompatible membranes might be helpful<\/li>\n<li>In critically ill patients who may already have some degree of predialytic hypoxia, it is necessary to increase the ventilated volumes and\/or the percentage of FiO<sub>2<\/sub><\/li>\n<li>Improvement in SAS has been reported with the use of prolonged dialysis such as nocturnal and daily hemodialysis<sup>2,3<\/sup><\/li>\n<\/ul>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid\" style=\"width:100%;margin-top:20px;margin-bottom:20px;border-top-width:1px;border-color:#dddddd;\"><\/div>\n<h4>References:<\/h4>\n<ol>\n<li>De Broe ME, De Backer WA. Pathophysiology of hemodialysis-associated hypoxemia. <em>Adv Nephrol Necker Hosp<\/em> 18:297-315, 1989<\/li>\n<li>Hanly PJ, Pierratos A. Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. <em>N Engl J Med<\/em>\u00a0 344:102-107, 2001<\/li>\n<li>Friedman EA. Hemodialysis as an artificial lung in sleep apnea. <em>N Engl J Med<\/em> 344:134-135, 2001<\/li>\n<\/ol>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[5],"tags":[60],"language":[41],"articles":[268],"class_list":["post-1234","article","type-article","status-publish","format-standard","hentry","category-articles","tag-intradialytic","language-english","articles-hemodialysis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Hypoxia - Advanced Renal Education Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/hypoxia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hypoxia - Advanced Renal Education Program\" \/>\n<meta property=\"og:description\" content=\"During hemodialysis, PaO2\u00a0falls about 10-20 mmHg. 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