Characteristics of hypotension-prone haemodialysis patients: is there a critical relative blood volume?

Barth, Cláudia; Boer, Walter; Garzoni, Daniela; Kuenzi, Thomas; Ries, W; Schaefer, Ralf; Schneditz, Daniel; Tsobanelis, Theoharis; Sande, Frank van der; Wojke, Ralf; Schilling, H; Passlick–Deetjen, Jutta

doi:10.1093/ndt/gfg171

Cited by 113 publications

(100 citation statements)

References 11 publications

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“…Our study has revealed the high frequency of acute HD complications in ESRD patients on two weekly 4-hour HD sessions, some which were fatal. These complications, with profiles similar to those reported elsewhere 18,19 . were more likely to occur during nighttime dialysis when centers were particularly understaffed, and were determined by a combination of both patient-related and health service-related factors.…”

Section: Discussionsupporting

confidence: 89%

Evaluation of acute intradialytic complications, management & outcome in end-stage renal disease patients

Mj¹,

Muqueet

Sharmeen³

et al. 2013

Comm. Based Med J

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Little is known about the challenges of routine renal replacement therapy in Bangladesh. We investigated the fatal and nonfatal acute hemodialysis complications in patients with end stage renal disease (ESRD) in dialysis centers in Mymensingh. 500 consecutive hemodialysis sessions incurred over a 4-month period by 50 patients with ESRD, receiving two weekly hemodialysis sessions of 4 hours each were considered. Personal and clinical profiles before, during, and within 24 hours after hemodialysis sessions were used to diagnose complications. The mean age of the patients was 45.5 ± 16.8 years and the lowest and highest ages were 17 and 82 years respectively. Male was predominant of the patients and male to female ratio was 2:1. Hypotension, muscular cramps, pruritus, nausea and vomiting were the common complications in end-stage renal disease patients. Twenty eight percent of patients presented with hypertensive crisis, 34% fever, 18% bleeding, 44% headache, 32% vomiting, 16% lumber pain, 16% palpitations, 22% disequilibrium syndrome, 36% dyspnea, 28% chest pain, 20% syncope, 32% abdominal problem, 44% neurological problem, 46% electrolyte imbalance, 34% articular & musculoskeletal problems, 48% cramps, 38% convulsions and 20% loss of consciousness. The vascular access was the main bleeding site of the patients (44.5%), followed by 33.3% through nose and 22.2% digestive tract bleeding. Most of patients experienced muscular cramps, hypertensive crisis, pruritus, vomiting, palpitations, disequilibrium syndrome, dyspnea, chest pain, neurologic problem, electrolyte disorders, nausea, vomiting, convulsions and loss of consciousness in shorter duration of dialysis than those in longer duration of dialysis sessions. Bleeding, disequilibrium syndrome and cardiovascular disease were leading cause of death in end-stage renal disease patients. Those complications occurred mostly during understaffed periods. Urgent strategies are needed to quickly solve the human capital crisis in the health care sector.

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Section: Discussionsupporting

confidence: 89%

Evaluation of acute intradialytic complications, management & outcome in end-stage renal disease patients

Mj¹,

Muqueet

Sharmeen³

et al. 2013

Comm. Based Med J

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“…Large-volume ultrafiltration was only weakly associated with intradialytic hypotension in our analysis, which is consistent with a previous study that demonstrated no correlation between the reduction in relative plasma volume and intradialytic hypotension. 18 The development of intradialytic hypotension is a complex process that depends on more than just the volume of ultrafiltration because susceptible patients may have an individualized threshold ultrafiltration volume 19 in addition to other factors such as impaired arteriolar tone, left ventricular dysfunction, and autonomic instability. 20 -22 We did not show a significant association of sex, current smoking, or diabetes mellitus on the relative rates of access thrombosis, consistent with several previous studies.…”

Section: Discussionmentioning

confidence: 99%

Intradialytic Hypotension and Vascular Access Thrombosis

Chang¹,

Paik²,

Greene³

et al. 2011

Journal of the American Society of Nephrology

181

156

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Identifying potential modifiable risk factors to reduce the incidence of vascular access thrombosis in hemodialysis could reduce considerable morbidity and health care costs. We analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and/or lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. Our primary outcome measure was episodes of vascular access thrombosis occurring within a given 6-month period during HEMO study follow-up. There were 2005 total episodes of vascular access thrombosis during a median 3.1 years of follow-up. The relative rate of thrombosis of native arteriovenous fistulas for the highest quartile of intradialytic hypotension was approximately twice that of the lowest quartile, independent of predialysis systolic BP and other covariates. There was no significant association of intradialytic hypotension with prosthetic arteriovenous graft thrombosis after multivariable adjustment. Higher predialysis systolic BP was associated with a lower rate of fistula and graft thrombosis, independent of intradialytic hypotension and other covariates. In conclusion, more frequent episodes of intradialytic hypotension and lower predialysis systolic BP associate with increased rates of vascular access thrombosis. These results underscore the importance of including vascular access patency in future studies of BP management in hemodialysis.

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“…The original aim of RPV monitors was to prevent intradialytic hypotension and related morbid events [107]. Various studies however have shown diverging results [108,109,110,111], even higher mortality and hospitalizations with the use of this technique [111]. …”

Section: Methods Of Dry Weight Assessment: An Overviewmentioning

confidence: 99%

Significance of Interdialytic Weight Gain versus Chronic Volume Overload: Consensus Opinion

et al. 2013

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Predialysis volume overload is the sum of interdialytic weight gain (IDWG) and residual postdialysis volume overload. It results mostly from failure to achieve an adequate volume status at the end of the dialysis session. Recent developments in bioimpedance spectroscopy and possibly relative plasma volume monitoring permit noninvasive volume status assessment in hemodialysis patients. A large proportion of patients have previously been shown to be chronically volume overloaded predialysis (defined as >15% above ‘normal' extracellular fluid volume, equivalent to >2.5 liters on average), and to exhibit a more than twofold increased mortality risk. By contrast, the magnitude of the mortality risk associated with IDWG is much smaller and only evident with very large weight gains. Here we review the available evidence on volume overload and IDWG, and question the use of IDWG as an indicator of ‘nonadherence' by describing its association with postdialysis volume depletion. We also demonstrate the relationship between IDWG, volume overload and predialysis serum sodium concentration, and comment on salt intake. Discriminating between volume overload and IDWG will likely lead to a more appropriate management of fluid withdrawal during dialysis. Consensually, the present authors agree that this discrimination should be among the primary goals for dialysis caretakers today. In consequence, we recommend objective measures of volume status beyond mere evaluations of IDWG.

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Characteristics of hypotension-prone haemodialysis patients: is there a critical relative blood volume?

Abstract: An individual RBV limit exists for nearly all patients. In most IME-prone patients, these RBV values were stable with only narrow variability, thus making it a useful indicator to mark the individual window of haemodynamic instabilities.

Cited by 113 publications

References 11 publications

Evaluation of acute intradialytic complications, management & outcome in end-stage renal disease patients

Evaluation of acute intradialytic complications, management & outcome in end-stage renal disease patients

Intradialytic Hypotension and Vascular Access Thrombosis

Significance of Interdialytic Weight Gain versus Chronic Volume Overload: Consensus Opinion

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