Model based sensitivity analysis of arterial pressure response to hemodialysis induced hypovolemia.

The role of hemodynamic and regulatory factors in the arterial pressure response to hemodialysis induced hypovolemia was investigated by means of a computer model of the cardiovascular system, including the main short-term pressure regulatory mechanisms. The model mimics the arterial and venous systemic circulation, Starling's law and inotropic heart regulation, arterial and cardiopulmonary baroreflex controls of resistance, and capacitance vessels. All of the model parameters have a clear physiologic meaning: 10 represent the systemic circulation, 4 describe cardiac pump performance, and 3 characterize baroreflex regulation. Sensitivity analysis is performed to determine the effect of each parameter on the pressure response to mild hypovolemia (a 10% blood volume reduction after 4 hours). The results demonstrate that circulatory parameters, such as resistances and compliances, have no relevant effect upon the pressure response. Conversely, regulation of venous capacity seems to play a pivotal role in sustaining arterial pressure during hemodialysis induced hypovolemia. Regulation of systemic peripheral resistance exerts a compensatory action only as long as the blood volume reduction is < 5%, but it is inadequate to compensate for a larger blood volume reduction when venous capacity regulation is absent. A paradoxical arterial pressure increase during hypovolemia can be referred to a prevalence of cardiopulmonary afferences in the regulatory process.