Running on the Empty: hemodialysis patients with fluid overload, low blood pressure, and intractable congestive heart failure

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Awad El-Magbri Shaukat Rashid Balhinder Brar


The authors presented a case of congestive heart failure in a patient with end-stage renal disease on hemodialysis. The patient has low blood pressure and fluid overload making removal of the fluid by hemodialysis challenging task. The authors put a theory forward for discrepancies in the pressure between the two sides of the heart and propose a surgical procedure “septetomy of the inter-atrial septum” that might resolve the issue of hypotension on dialysis patients with fluid overload.

Keywords: hemofiltration, hemodialysis, congestive heart failure, ultra-filtration, fluid overload, Intre-atrial septetomy

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How to Cite
EL-MAGBRI, Awad; RASHID, Shaukat; BRAR, Balhinder. Running on the Empty: hemodialysis patients with fluid overload, low blood pressure, and intractable congestive heart failure. Medical Research Archives, [S.l.], v. 6, n. 3, mar. 2018. ISSN 2375-1924. Available at: <>. Date accessed: 09 dec. 2023. doi:
Research Articles


1. Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, Anderson J. Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease. Nephrol Dial Transplant. 2006; 21: 1257-62
2. Duranti E, Imperiali P, sasdelli M. Is hypertension a mortality risk factor in dialysis? Kidney Int. 1996; 55: S173-S174
3. Fleischmann EH, Bower JD, Salahudeen AK. Risk factor paradox in hemodialysis: better nutrition as a partial explanation. ASAIO J. 2001; 47: 74-81
4. Iseki K, Miyasato F, Tokuyama K, et al. Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. Kidney Int. 1997; 51: 1212-17
5. Klassen PS, Lowrie EG, Reddan DN, et al. Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis. JAMA 2002; 287: 1548-55
6. Port FK, Hulbert-Shearon TE, Wolfe RA, et al. Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999; 33: 507- 17
7. Zager PG, Nikolic J, Brown RH, et al. “U” curve association of blood pressure and mortality in hemodialysis patients. Medical directors of Dialysis Clinic. Inc Kidney Int. 1998; 54: 561-569
8. Coresh J, Longenecker JC, Miller ER, Young HJ, Klag MJ. Epidemiology of cardiovascular risk factors in chronic renal disease. J Am Soc Nephrol. 1998; 9: S24-S30
9. MacFadyen RJ, Ng Kam Chuen MJ, Davis RC. Loop diuretic therapy in left ventricular systolic dysfunction: has familiarity bred contempt for a critical but potentially nephrotoxic cardio renal therapy? Eur J Heart Fail. 2010; 12(7): 649-652
10. Butler J, Forman DE, Abraham WT, et al. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J. 2004; 147(2): 331-338
11. Knight EL, Glynn RJ, McIntyre KM, Mogun H, Avorn J. Predictors of decreased renal function in patients with heart failure during angiotensin-converting enzyme inhibitor therapy: results from the studies of left ventricular dysfunction (SOLVD). Am Heart J. 1999; 138(5Pt 1): 849-855.
12. Kazory A, Ross EA. Contemporary trends in the pharmacological and extra-corporeal management of heart failure: a nephrologic perspective. Circulation. 2008; 117(7): 975-983.
13. Canaud B, Leblanc M, Leray-Moragues H, Delmas S, Klouche K, Breaud JJ. Slow continuous and daily ultrafiltration for refractory congestive heart failure. Nephrol Dial Transplant. 1998; 13(4): 51-55.
14. Baldamus CA. Hemofiltration. In: Henderson LW, Quellhorst EA, Lysaght MJ, eds, hemodynamics in hemofiltration. Springer-Verlag, Berlin. 1986: 156-200.
15. Quellhorst EA. Ultrafiltration/ hemofiltration practice In: Jacobs C, Kjellstrand CM, Koch KM, Winchester JF, eds. Replacement of renal function by dialysis. Kluwer Academic Publishers. Dordrecht. 1996: 380-389.
16. Canaud B, Cristol JP, Klouche K, et al. Slow continuous ultrafiltration: a means of unmasking myocardial functional reserve in end-stage cardiac disease. Contrib Nephrol. 1991; 93: 79-85.
17. Simpson LA, Rae AP, Simpson K, et al. Ultrafiltration in the management of refractory congestive heart failure. Br Heart J. 1986; 55: 344-347.
18. Rimondini A, Cipolla CM, Della Bella P, et al. Hemofiltration as short-term treatment for refractory congestive heart failure. Am J Med. 1987; 83: 43- 48.
19. Coraim FI, Wolner E. Continuous hemofiltration for the failing heart. New Horizons. 1995; 3: 725-731.