Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Medical Biophysics

Supervisor

McIntyre, Christopher W.

Abstract

Hemodialysis (HD) provides life-saving treatment in individuals with kidney failure. However, HD is associated with poor quality of life and extremely high mortality rates mainly caused by cardiovascular disease due to heart failure and sudden cardiac death. Standard pharmacological treatment developed within the non-kidney disease community are largely ineffective in HD patients because of the difference in pathophysiology of cardiovascular mortality. HD treatment causes hypotension and recurrent ischemic injury to multiple vascular beds including the heart, leading to heart failure. These injuries can be abrogated by improving the patient’s tolerability of the treatment. To apply interventions that may improve hemodynamic tolerability of HD, it is crucial to understand the mechanisms of HD-induced injury at every layer of the vasculature: the endothelial, microvasculature and macrovasculature. The purpose of this thesis was to study the endothelial and vascular dysfunction effecting tissue perfusion as a result of HD and under conditions of intradialytic exercise and alteration of dialysate sodium concentration.

Summary for Lay Audience

Kidney failure is common, and it is the inability for the kidneys to clean the blood in our body from waste and toxins. The build-up of waste products can be very dangerous, and it must be removed regularly by a machine (hemodialysis, HD) that acts as an artificial kidney. HD is a life-saving therapy but people who need it die much more often than people with healthy kidneys. The most common cause of death in patients on HD is heart failure. This is because HD requires removal of blood from your body into a circuit that is outside of your body, causing the blood flow in the small blood vessels in the heart tissues to fall. Low blood flow means not enough oxygen will be delivered to the tissue causing it to fail. The purpose of this thesis was to study the changes in the blood vessels effecting blood flow in the tissue due to HD and under conditions of exercise and alteration in sodium levels of the dialysis fluid.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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