Intradialytic hypotension

Gul, Ambreen; Miskulin, Dana C.; Harford, Antonia; Zager, Philip G.

doi:10.1097/mnh.0000000000000271

Cited by 50 publications

(46 citation statements)

References 41 publications

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“…DIH is usually associated with a burden of symptoms such as muscle cramps, abdominal and chest pain, nausea and vomiting, weakness, dyspnea, dizziness, anxiety, and sweating, which significantly diminish patient's quality of life [7]. In addition, DIH is independently associated with mortality [7,8], so that any attempt to reduce its prevalence is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

et al. 2017

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Background: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. Methods: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) ≥20 mm Hg. Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone. Conclusion: Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal.

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Section: Discussionmentioning

confidence: 99%

“…In addition, DIH is independently associated with mortality [7,8], so that any attempt to reduce its prevalence is warranted.…”

Section: Discussionmentioning

confidence: 99%

Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

et al. 2017

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“…IDH may be caused by potentially life‐threatening conditions, and these must be rapidly evaluated and treated as needed. Conditions include acute hemolysis, air embolus, dialyzer reaction, coronary ischemia, pulmonary embolism, pericardial tamponade, bleeding, and sepsis . Acute management steps for all causes should occur simultaneously.…”

Section: Prevention and Management Of Intradialytic Hypotension (Table )mentioning

confidence: 99%

“…Cooling can be achieved using an empiric fixed reduction in temperature, or through a biofeedback device. The mechanism by which cooled dialysate reduced IDH is not clearly understood, but likely involves increased systemic vascular resistance by activation of the sympathetic nervous system Dialysis frequency and duration—modifying a patient's routine hemodialysis schedule to longer hours and/or more frequent treatments per week may reduce the risk of IDH, as more frequent sessions will decrease IDWG, and longer sessions will decrease ultrafiltration rates .…”

Section: Prevention and Management Of Intradialytic Hypotension (Table )mentioning

confidence: 99%

A brief review of intradialytic hypotension with a focus on survival

Chou

Kalantar-Zadeh

Mathew

2017

Seminars in Dialysis

106

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Intradialytic hypotension (IDH), a common complication of ultrafiltration during hemodialysis therapy, is associated with high mortality and morbidity. IDH, defined as a nadir systolic blood pressure of less than 90 mmHg on more than 30% of treatments, is a relevant definition and is correlated with mortality. Risk factors for IDH include patient demographics, anti-hypertensive medication use, larger interdialytic weight gain, and dialysis prescription features as dialysate sodium, high ultrafiltration rate, and dialysate temperature. A high frequency of IDH events carries a substantial death risk. An ultrafiltration rate >10mL/hr/kg, and even more so >13mL/hr/kg, is highly predictive of cardiovascular and all-cause mortality. Evidence suggests that IDH causes acute reversible segmental myocardial hypoperfusion and contractile dysfunction (myocardial stunning), which can result in long-term loss of myocardial contractility, leading to premature death. IDH also has negative end-organ effects on the brain and gut, contributing to mortality through stroke, and endotoxin translocation with associated inflammation and protein-energy wasting. Given strong association of IDH and dialysis mortality, a paradigm shift to its approach is urgently needed. Randomized controlled trials are required to prospectively test drugs and monitoring devices which may reduce IDH.

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“…Fluid overload is associated with elevated blood pressure, left ventricular hypertrophy, vascular stiffness, and increased mortality . At the same time, aggressive volume removal is associated with intradialytic hypotension, which, in turn, is associated with myocardial stunning, earlier loss of residual kidney function, greater mortality and morbidity . In a large prevalent cohort of US dialysis patients, those either above or below their estimated dry weight in 30% or more of dialysis sessions had higher mortality rates .…”

Section: Introductionmentioning

confidence: 99%