Intensive Hemodialysis and Treatment Complications and Tolerability

Abstract

Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90mmHg and intradialytic decline > 30mmHg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common. In DOPPS (Dialysis Outcomes and Practice Patterns Study), recovery time was 2 to 6 hours for 41% of HD patients and longer than 6 hours for 27%; recovery time was linearly associated with increased risks for death and hospitalization. Importantly, both decreases in blood pressure and feeling washed out or drained have been identified by patients as more important outcomes than death or hospitalization. Intensive HD likely reduces the likelihood of IDH. In the Frequent Hemodialysis Network trial, short daily and nocturnal schedules reduced the per-session probability of IDH by 20% and 68%, respectively, relative to 3 sessions per week. Due to lower ultrafiltration volume and/or rate, intensive HD may reduce intradialytic blood pressure variability. In a cross-sectional study, short daily and nocturnal schedules were associated with slower ultrafiltration and less dialysis-induced myocardial stunning than 3 sessions per week. In FREEDOM (Following Rehabilitation, Economics, and Everyday-Dialysis Outcome Measurements), a prospective cohort study of short daily HD, recovery time was reduced after 12 months from 8 hours to 1 hour, according to per-protocol analysis. Recovery time after nocturnal HD may be minutes. In conclusion, intensive HD can improve the tolerability of HD treatment by reducing the risk for IDH and decreasing recovery time after HD. These changes may improve the patient centeredness of end-stage renal disease care.

Low dialysate potassium concentration is associated with prolonged recovery time

“…Patients frequently note that recovery time post hemodialysis is a more important outcome for them than death or hospitalization . The reported recovery times in this QA project were comparable to those reported in the literature . The high polychoric correlation coefficients we observed within individual patients establish the reliability of the answers to the recovery question asked on a repetitive basis.…”

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

“…Therefore, it is of utmost importance to find an optimal balance between prevention of fluid overload on one hand and haemodynamic tolerance on the other, which can be very difficult to achieve using thrice weekly treatments. While prevention of interdialytic weight gain by sodium restriction is a cornerstone of treatment [41], the dilemma between too rapid fluid removal and persistent fluid overload may in some cases be solved only by increasing dialysis time and/or frequency [42]. As preventive methods have been discussed in detail both in older and more recent literature [8, 23], we will focus here on recently published trials.…”

Complicações Em Pacientes Renais Crônicos Submetidos À Hemodiálise

“…Estudo (11) destaca a hipotensão como uma das principais complicações agudas durante o procedimento hemodialítico, identificando a sua prevalência em 50% de pacientes do sexo feminino submetidos à hemodiálise, com faixa-etária média de 47 anos, corroborando com os dados do presente estudo (11) . Quanto ao ganho de peso, pacientes com excesso de líquido estão mais propensos à redução da pressão arterial devido à maior remoção de líquido e de eletrólitos durante as sessões, principalmente se o volume de ultrafiltração for rápido ou excessivo (12) . Nesse contexto, a clientela submetida à hemodiálise, em especial adultos do sexo feminino, que vivencia o ganho de peso em curto período, reflete aumento à vulnerabilidade para complicações como a hipotensão arterial.…”