Evaluation of intradialytic hypotension using impedance cardiography

Bayya, Abed; Rubinger, Dvora; Linton, David M.; Sviri, Sigal

doi:10.1007/s11255-010-9746-3

Cited by 8 publications

(2 citation statements)

References 40 publications

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“…These mechanisms are predominantly regulated by the sympathetic nervous system and the renin-angiotensin system. Although dialysis patients generally have an overactive sympathetic nervous system and renin-angiotensin system [8,9,10,11,12], the increase in peripheral resistance is insufficient to prevent intradialytic hypotension in many patients [13,14]. As a consequence, the role of the vasoconstrictor arginine vasopressin (AVP) for maintaining blood pressure may become increasingly important [15,16,17].…”

Section: Introductionmentioning

confidence: 99%

Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

Ettema¹,

Zittema²,

Kuipers

et al. 2014

Am J Nephrol

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Background: Intradialytic hypotension is a common complication of hemodialysis (HD). Some studies have suggested that inadequate arginine vasopressin (AVP) increase could play a role in the pathogenesis of intradialytic hypotension. However, AVP levels during HD and its relation to hypotension has never been systematically studied. Summary: PubMed and Embase were searched (1970-2013, search terms ‘vasopressin' and ‘hemodialysis') for studies reporting on AVP levels during standard HD or other dialysis techniques. Observational studies reporting on AVP levels pre- and postdialysis were additionally included in a meta-analysis. Thirty-seven studies were included in the systematic literature review, of which 26 studies were eligible for meta-analysis. The main findings were that pretreatment AVP levels were higher in dialysis patients compared with healthy controls (6.4 ± 3.5 vs. 2.5 ± 1.3 pg/ml, p = 0.003) and that plasma AVP levels showed little or no increase during HD (from 7.0 ± 4.9 to 8.8 ± 9.3, p = 0.433). Significant heterogeneity was found between studies. Meta-regression analysis revealed no significant associations between AVP and patient or study characteristics. Studies on other dialysis techniques showed mixed results regarding the AVP course. The eight studies that addressed the relation between intradialytic hypotension and AVP also showed inconsistent results. Key Messages: Plasma AVP levels are higher in dialysis patients compared with healthy controls, but show little or no increase during HD. The lack of a rise in AVP levels during HD may be pathophysiologically involved in the onset of intradialytic hypotension, but firm conclusions are not possible from our review of the literature.

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Section: Introductionmentioning

confidence: 99%

Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

Ettema¹,

Zittema²,

Kuipers

et al. 2014

Am J Nephrol

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“…The mechanisms responsible for decreased BP during HD are rapid excessive ultrafiltration , a rapid reduction in plasma osmolality , an incorrectly low prescribed target weight , autonomic neuropathy , diminished cardiac reserve , excessive antihypertensive medications , and the composition and temperature of the dialysate fluid . Bayya et al demonstrated that a lower calculated end‐diastolic filling ratio, which is defined as the diastolic amplitude of the impedance cardiogram divided by the systolic amplitude, was an independent predictor for decreased BP during HD . The low end‐diastolic filling ratio may be regarded as a marker for a reduced preload in these patients.…”

Section: Discussionmentioning

confidence: 99%

High Stroke Volume Variation Is an Independent Predictor for Decreased Blood Pressure During Hemodialysis

et al. 2017

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It currently remains unclear whether stroke volume variation (SVV) before hemodialysis (HD) is an independent predictor of decreased blood pressure (BP) during HD. Fifty-two patients were divided into two groups (Decreased BP during HD group: N = 10, Non-decreased BP group: N = 42). Fractional shortening was lower, and mean arterial pressure (MAP) and SVV were higher in the Decreased BP during HD group. A multiple logistic regression analysis identified low fractional shortening, high MAP, and high SVV as independent predictors of decreased BP during HD. The areas under the ROC curves were as follows: 0.849 for MAP, 0.712 for SVV, and 0.893 for MAP and SVV. Optimal threshold values were 93.0 mm Hg for MAP and 17.3 % for SVV. A multivariate regression analysis identified anemia and a longer dialysis vintage as independently related factors for higher SVV. Our results suggest that high SVV is an independent predictor for decreased BP during HD.

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Hypertension in End-Stage Kidney Disease: Dialysis

Schaefer

2023

Pediatric Hypertension

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Evaluation of intradialytic hypotension using impedance cardiography

Cited by 8 publications

References 40 publications

Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

Dialysis Hypotension: A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

High Stroke Volume Variation Is an Independent Predictor for Decreased Blood Pressure During Hemodialysis

Hypertension in End-Stage Kidney Disease: Dialysis

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