Dialysate sodium and intradialytic hypotension

Hussein, Wael F.; Schiller, Brigitte

doi:10.1111/sdi.12634

Cited by 19 publications

(18 citation statements)

References 38 publications

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“…Nonetheless, in an exploratory analysis we found patients who reported a longer DRT category in the incident period had higher unadjusted 6-, 12-and 24-month hospitalization rates, which is similar to prior ndings in prevalent HD [15]. Other limitations of our study include not accounting for dialysate sodium, which has been found to be inversely associated to DRT presumably on account of higher hemodynamic instability [15,22,23]. However, the gradient in blood/dialysate sodium and potential variations in intradialytic tonicity might be independently associated to longer DRT.…”

Section: Discussionsupporting

confidence: 78%

Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

Guedes

Pécoits-Filho

Leme

et al. 2020

Preprint

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Background:Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT >2hours. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis.Methods:We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: <0.5, 0.5-to-1, 1-to-2, 2-to-4, or >4 hours. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT >2 hours) in reference to a change to a shorter DRT (decrease below DRT <2 hours, or from DRT >4 hours). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (>365-to-≤545 days FDD) and second prevalent (>730-to-≤910 days FDD) years.Results:Among 98616 incident HD patients (age 62.6±14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR=0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR=1.008; 95%CI 1.001-to-1.015) and 1.6% (OR=1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time.Conclusions:Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

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Section: Discussionsupporting

confidence: 78%

Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

Guedes

Pécoits-Filho

Leme

et al. 2020

Preprint

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“…Limitations of our study include not accounting for dialysate sodium, which has been found to be inversely associated to DRT presumably on account of higher hemodynamic instability (15,22,23). However, the gradient in blood/dialysate sodium and potential variations in intradialytic tonicity might be independently associated to longer DRT.…”

Section: Discussionmentioning

confidence: 90%

Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

Guedes

Pécoits-Filho

Leme

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Patient reported long dialysis recovery time (DRT) is common and associated with higher hospitalization and mortality. The goal of our study was to test the hypothesis that hemodialysis (HD) dose and intradialytic hypotension (IDH) rates are associated with dialysis recovery time (DRT). Methods: We analyzed data from adult HD patients who responded to DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: <0.5, 0.5-to-1, 1-to-2, 2-to-4, or >4 hours. An adjusted logistic regression model computed odds ratio for increased/maintained longer DRT (increase above DRT >2 hours) in reference to decreased/maintained shorter DRT (decrease below DRT <2 hours, or from DRT >4 hours). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (>365-to-≤545 days FDD) and second prevalent (>730-to-≤910 days FDD) years. Results: Among 98616 incident HD patients (age 62.6±14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR=0.865; 95%CI 0.801-to-0.935) lower risk of longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes/month in the incident period was associated with a 0.8% (OR=1.008; 95%CI 1.001-to-1.015) and 1.6% (OR=1.016; 95%CI 1.006-to-1.027) higher probability of a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to longer DRT over time. Conclusions: Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

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“…It is unclear if modification of sodium, whether in the dialysate or in the diet, is beneficial in HFrEF. Higher dialysate sodium can reduce the incidence of intradialytic hypotension but also leads to higher interdialytic weight gains, which necessitates a higher UFR, increasing the risk of intradialytic hypotension and associated morbidities 34 . The most recent guidelines for the management of HFrEF state that dietary sodium restriction is reasonable, as it may reduce fluid retention and congestive symptoms but may be associated with higher hospitalization rates thought to be mediated through increased neurohormonal activation 9,35,36 .…”

Section: Dialysis Modality and Dialysis‐related Treatment Strategies mentioning

confidence: 99%

Heart failure management in dialysis patients: Many treatment options with no clear evidence

Roehm

Gulati

Weiner

2020

Seminars in Dialysis

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Heart failure with reduced ejection fraction (HFrEF) impacts approximately 20% of dialysis patients and is associated with high mortality rates. Key issues discussed in this review of HFrEF management in dialysis include dialysis modality choice, vascular access, dialysate composition, pharmacological therapies, and strategies to reduce sudden cardiac death, including the use of cardiac devices. Peritoneal dialysis and more frequent or longer duration of hemodialysis may be better tolerated due to slower ultrafiltration rates, leading to less intradialytic hypotension and better volume control; dialysate cooling and higher dialysate calcium may also have benefits. While high‐quality evidence exists for many drug classes in the non‐dialysis population, dialysis patients were excluded from major trials, and only limited data exist for many medications in kidney failure patients. Despite limited evidence, beta blocker and angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker use is common in dialysis. Similarly, devices such as implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy that have proven benefits in non‐dialysis HFrEF patients have not consistently been beneficial in the limited dialysis studies. The use of leadless pacemakers and subcutaneous ICDs can mitigate future hemodialysis access limitations. Additional research is critical to address knowledge gaps in treating maintenance dialysis patients with HFrEF.

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Dialysate sodium and intradialytic hypotension

Cited by 19 publications

References 38 publications

Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

Impacts of Dialysis Adequacy and Intradialytic Hypotension on Changes in Dialysis Recovery Time

Heart failure management in dialysis patients: Many treatment options with no clear evidence

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