Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

Tian, Maolu; Zha, Yan; Qie, Shuwen; Xin, Lin; Yuan, Jing

doi:10.1159/000504245

Cited by 19 publications

(17 citation statements)

References 34 publications

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“…Consistent with the findings of our study, Koziolek et al measured changes in whole body bioimpedance in a small number of patients and concluded that multifrequency BIA was not able to predict the onset of hypotension 15 . Although two other reports published recently have suggested a positive correlation between body compositions with intradialytic hypotension, these study findings were limited to only pre‐dialysis, and body composition pre‐dialysis is confounded by fluid status 13,14 …”

Section: Discussionsupporting

confidence: 87%

“…We hypothesized that if there was a greater fall in ECW compared to ICW during HD, then patients would be at greater risk of intradialytic hypotension. [13][14][15] Understanding the physiology, changes in hydration status, and correlation with hypotension during HD session itself using BIA may provide insight on advancement in monitoring and preventive tools to reduce the risk of intradialytic hypotension. We, therefore, studied changes in hydration status and relative change in ECW to ICW (EIR) in different body segments in high-risk ESRD patients during HD sessions.…”

Section: Introductionmentioning

confidence: 99%

“…Although several observational studies have measured bioimpedance pre‐dialysis and then reported on factors which may be associated with intradialytic hypotension, there are very few studies which have prospectively measured bioimpedance throughout the hemodialysis sessions. We hypothesized that if there was a greater fall in ECW compared to ICW during HD, then patients would be at greater risk of intradialytic hypotension 13–15 . Understanding the physiology, changes in hydration status, and correlation with hypotension during HD session itself using BIA may provide insight on advancement in monitoring and preventive tools to reduce the risk of intradialytic hypotension.…”

Section: Introductionmentioning

confidence: 99%

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Changes in total and segmental extracellular and intracellular volumes with hypotension during hemodialysis measured with bioimpedance spectroscopy

et al. 2021

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Background: Bioelectrical impedance analysis (BIA) devices have been advocated to guide volume management in hemodialysis (HD) patients. We hypothesized that understanding the dynamics of fluid shifts in different body segments may provide additional insight on preventive measures to reduce the risk of intradialytic hypotension.Methods: A prospective observational study was conducted among 42 HD patients at risk of hypotension who were admitted as emergencies inpatient.Results: A total of 191 BIA measurements were made during the 42 HD sessions, and hypotension occurred during 52 measurements (27%). The extracellular water (ECW) to intracellular water ratio (EIR) was measured in different body segments and declined significantly only in the non-access arm with increasing HD session duration (β = −0.04; 95% confidence interval (CI): −0.05 to −0.03, p < 0.01). There was no significant association between EIR and hypotension with respect to the different body segments. Only pre-HD N-terminal-pro btype natriuretic peptide was significantly associated with hypotension (β = 0.20, 95% CI: 0.04 to 0.89, p = 0.04). There was no association between relative blood volume monitoring change and EIR. Conclusion:In summary, we found that segmental BIA during HD was unable to detect or predict hypotension during dialysis. Although BIA is able to provide information about ECW and guide clinical assessment of volume in HD patients prior to dialysis, our findings did not suggest the use of serial measurements of changes in EIR in different body segments during HD provided sufficient information to predict intradialytic hypotension. Similarly, changes in EIR did not provide information on changes in plasma volume that could potentially trigger interventions to prevent or reduce intra-dialytic hypotension.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in total and segmental extracellular and intracellular volumes with hypotension during hemodialysis measured with bioimpedance spectroscopy

et al. 2021

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“…BMI is linked to IDWG and therefore UFR, but patients with higher BMI appear to be able to better tolerate larger UFV and fluid depletion. 34 Two studies showing that BMI had no association with IDH, whereas increased fat and reduced lean tissue were associated with IDH, 35 , 36 may point to the problems in BMI as a surrogate for body composition. IDWG is independently linked to IDH 37 and mortality 38 ; however, IDWG is also strongly linked to nutrition, and this has been shown to impact on the relationship between IDWG and mortality.…”

Section: Discussionmentioning

confidence: 99%

The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality

Keane

Raimann

Zhang

et al. 2021

Kidney International

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Intradialytic hypotension (IDH) is a common complication of hemodialysis, but there is no data about the time of onset during treatment. Here we describe the incidence of IDH throughout hemodialysis and associations of time of hypotension with clinical parameters and survival by analyzing data from 21 dialysis clinics in the United States to include 785682 treatments from 4348 patients. IDH was defined as a systolic blood pressure of 90 mmHg or under while IDH incidence was calculated in 30-minute intervals throughout the hemodialysis session. Associations of time of IDH with clinical and treatment parameters were explored using logistic regression and with survival using Cox-regression. Sensitivity analysis considered further IDH definitions. IDH occurred in 12% of sessions at a median time interval of 120-149 minutes. There was no notable change in IDH incidence across hemodialysis intervals (range: 2.6-3.2 episodes per 100 session-intervals). Relative blood volume and ultrafiltration volume did not notably associate with IDH in the first 90 minutes but did thereafter. Associations between central venous but not arterial oxygen saturation and IDH were present throughout hemodialysis. Patients prone to IDH early as compared to late in a session had worse survival. Sensitivity analyses suggested IDH definition affects time of onset but other analyses were comparable. Thus, our study highlights the incidence of IDH during the early part of hemodialysis which, when compared to later episodes, associates with clinical parameters and mortality.

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“…Cardiac hemodynamic instability during hemodialytic procedure were evaluated by IDH, and myocardial ischemia. A decrease in SBP ≥ 20 mmHg or mean arterial pressure (MAP) ≥ 10 mmHg was required to quantify hypotension and ≥3 episodes hypotension per 10 hemodialysis treatments were required to diagnose IDH 29 . The rate-pressure product (RPP) was calculated as SBP multiplied by HR and the change in RPP as the percentage difference between the maximum value and the minimum value during dialysis session 13 .…”

Section: Study Protocolmentioning

confidence: 99%

Long-Term Predialysis Systolic Blood Pressure Variability and Intradialytic Cardiac Hemodynamics in Hemodialysis Patients

Yang

Huang

et al. 2020

Preprint

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The association in hemodialysis patients between long-term predialysis blood pressure variability and intradialytic cardiac hemodynamics was assessed prospectively in 1070 patients receiving maintenance hemodialysis for more than 3 months. Predialysis blood pressure variability was assessed over 1-year intervals. Outcomes included factors were intradialytic hypotension and change in rate-pressure product. The final cohort’s mean age was 59 years, and 57% were males. Greater predialysis systolic blood pressure variability was associated with an increased risk of intradialytic hypotension (adjusted hazard ratio, 1.097; 95% confidence intervals 1.055 to 1.140) and change in rate-pressure product (adjusted hazard ratio, 1.213; 95% confidence intervals 1.163 to 1.265). Results were similar when blood pressure variability was stratified by baseline systolic blood pressure. Factors associated with higher systolic blood pressure variability were older age, female sex, longer duration of dialysis, and diagnosis of diabetic nephropathy, and lower levels of serum albumin. In conclusion, greater predialysis systolic blood pressure variability among hemodialysis patients was associated with greater intradialytic cardiac hemodynamic instability. Strategies to reduce blood pressure variability might be beneficial for hemodialysis patients.

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Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

Cited by 19 publications

References 34 publications

Changes in total and segmental extracellular and intracellular volumes with hypotension during hemodialysis measured with bioimpedance spectroscopy

Changes in total and segmental extracellular and intracellular volumes with hypotension during hemodialysis measured with bioimpedance spectroscopy

The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality

Long-Term Predialysis Systolic Blood Pressure Variability and Intradialytic Cardiac Hemodynamics in Hemodialysis Patients

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