EBPG guideline on haemodynamic instability

Kooman, Jeroen P.; Başçı, Alı; Pizzarelli, Francesco; Canaud, Bernard; Haage, Patrick; Fouque, Denis; Könner, Klaus; Martín‐Malo, Alejandro; Pedrini, Luciano A.; Tattersall, James; Tordoir, Jan H.M.; Vennegoor, Marianne; Wanner, Christoph; Wee, Piet ter; Vanholder, Raymond

doi:10.1093/ndt/gfm019

Cited by 210 publications

(248 citation statements)

References 157 publications

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“…According to EBPG guideline on hemodynamic instability, 6 IDH was defined as a decrease in systolic blood pressure !20 mmHg or a decrease in mean arterial pressure (MAP) by 10 mmHg associated with clinical events and need for nursing interventions.…”

Section: Intradialytic Hypotensionmentioning

confidence: 99%

“…In addition, IDH may cause organ hypoperfusion resulting in cardiac, neurologic, vascular, and gastrointestinal complications. [4][5][6][7][8] Overall, IDH causes discomfort, and reduces treatment efficacy, thus increases morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8] Several factors contribute to IDH, such as the compromised autonomic nervous system, hormonal response, and cardiovascular compensatory mechanisms, including vascular compliance, venous capacity, and cardiac function. In addition, during hemodialysis treatment, fast removal of intravascular fluid, slow refilling rates, increases in body temperature, components of the dialysis fluid (buffer, water and electrolytes), etc.…”

Section: Introductionmentioning

confidence: 99%

“…may cause hemodynamic instability. [5][6][7][8][9] However, the main factor causing an acute decrease in blood pressure during HD treatment is hypovolemia due to inadequate ultrafiltration. 10 It is well known that healthy subjects can tolerate a decline in circulating blood volume up to 20% before hypotension occurs, but in patients on chronic hemodialysis hypotension may occur with a significant smaller decline in blood volume.…”

Section: Introductionmentioning

confidence: 99%

“…10 It is well known that healthy subjects can tolerate a decline in circulating blood volume up to 20% before hypotension occurs, but in patients on chronic hemodialysis hypotension may occur with a significant smaller decline in blood volume. 6 Recently, Flythe et al 11 have demonstrated that systolic blood pressure variability in patients on chronic hemodialysis is associated with greater dialytic fluid removal and rate as well as with older age and dialytic age (DA).…”

Section: Introductionmentioning

confidence: 99%

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Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Bossola¹,

Laudisio²,

Antocicco³

et al. 2013

Renal Failure

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Objective: Intradialytic hypotension (IDH) is common in patients on chronic hemodialysis, but knowledge on determinants is still unclear. The present study aims at evaluating the association between IDH and dialytic age (DA) in patients on chronic hemodialysis. Methods: Between January 2012 and January 2013, 82 patients on chronic hemodialysis for at least 1 year were screened for inclusion in the present study. Of these, 14 were excluded because of advanced heart failure (n.9), history of alcohol/substance abuse (n.1), diagnosis of dementia (n.2), actual instability of clinical conditions requiring hospitalization (n.2). IDH was defined as a decrease in systolic blood pressure !20 mmHg or a decrease in mean arterial pressure (MAP) by 10 mmHg associated with clinical events and need for nursing interventions. The number of IDH episodes in 10 consecutive hemodialysis sessions was recorded for each patient. Linear and logistic regressions were adopted to assess the adjusted association between IDH and DA. Conclusion: DA is associated with an increased probability of IDH and with increased number of IHD events. Studies are needed to understand the underlying factors of such an association.

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Section: Intradialytic Hypotensionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Bossola¹,

Laudisio²,

Antocicco³

et al. 2013

Renal Failure

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Dialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysis

Tsujimoto

Nakata

et al. 2019

Cochrane Database of Systematic Reviews

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Clinical application of fuzzy‐controlled blood pressure stabilization in patients prone to hypotension during hemodialysis

Hickstein

Stange²,

Roeher

et al. 2009

Dialysis & Transplantation

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BACKGROUND The prevalence of intradialytic hypotensive events is still high in patients undergoing hemodialysis (HD). A biofeedback control system to prevent hypotensive destabilization of the patient during hemodialysis was developed. METHODS A blood pressure (BP)–guided closed‐loop system consists of a non‐invasive blood pressure measurement device connected to a fuzzy controller (FC). It regulates ultrafiltration rate (UFR) and dialysate conductivity (DC) depending on the actual BP and its short‐ and long‐term trends as well. Twenty‐eight HD patients prone to hypotension were selected for the study. In 102 HD sessions it was proven whether an increase in DC from 14.3 mS/cm to a maximum of 17.0 mS/cm infl uenced the serum sodium concentration of the patients and interdialytic weight gain (IDGW), when DC was reset to 14.3 mS/cm for the remaining 60 minutes of treatment. In the next step, 69 conventional HD sessions without the fuzzy controller and 144 sessions with fuzzy‐controlled ultrafiltration were compared with 32 sessions with simultaneous fuzzy‐controlled ultrafiltration and modification of dialysate conductivity. RESULTS No significant differences in serum sodium concentration and weight gain were observed when DC was reset for the remaining 60 minutes of treatment. In conventional HD the frequency of low blood pressure situations, <90 mmHg, increased progressively toward the end of the treatment. The HD treatments with fuzzy‐controlled UFR resulted in no increases in the number of hypotensive episodes. Moreover, there was a significant decrease in the third and fourth treatment hours. The simultaneous fuzzy control of UFR + DC resulted in the lowest occurrence of BP drops. CONCLUSIONS Fuzzy control of HD treatments provides reliable blood pressure stabilization in patients prone to hypotension. This kind of treatment is safe because significant changes in body weight and serum sodium concentration do not occur. The cost of this treatment is limited because no special disposables are necessary.

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EBPG guideline on haemodynamic instability

Cited by 210 publications

References 157 publications

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Dialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysis

Clinical application of fuzzy‐controlled blood pressure stabilization in patients prone to hypotension during hemodialysis

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