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Association of dialysis adequacy with portal pressure: a cross-sectional study in haemodialysis patients.
High intra-abdominal pressure is a cause of hepatic decompensation in end-stage renal failure patients on haemodialysis. The risk of portal hypertension increases with intra-abdominal pressure. The aim of this study was to assess the relationship between the mean urea reduction ratio (URR) and the mean effective blood volume (MBV) obtained by the spectrophotometric method, and the intra-abdominal pressure (IAP) in haemodialysis patients. A cross-sectional study was conducted with 40 haemodialysis patients (mean age 60 years; range 34-81). All patients underwent an evaluation of haemodynamics including IAP (measured by intravesical method), MBV (spectrophotometric method), bi-axillary blood pressure, heart rate, URR and dry weight. The mean creatinine clearance was 30.4 +/- 8.7 ml/min. One-hundred eighty-three measurements of URR and MBV were performed in the 40 patients. URR and MBV values showed a significant inverse correlation (r = -0.62, P or = 20 mmHg (group A) and MBV-URR (mean URR) relationship was significantly different from the rest of the patients (group B) (2.17 +/- 0.40 vs. 1.78 +/- 0.59 U, respectively; P = 0.02). These findings in group B patients were highly similar to the relationship of IAP and MBV in healthy subjects. The results of this study showed that the relationship between haemodialysis adequacy and mean IAP is nonlinear, and that, in patients with high IAP, the decrease in haemodialysis adequacy is proportional to the increase
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