Intradialytic Hypotension and Risk of Cardiovascular Disease

Stefánsson, Bergur V.; Brunelli, Steven M.; Cabrera, Claudia; Rosenbaum, David P.; Anum, Emmanuel A.; Ramakrishnan, Karthik; Jensen, Donna E.; Stålhammar, Nils-Olov

doi:10.2215/cjn.02680314

Cited by 257 publications

(212 citation statements)

References 24 publications

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“…But in a recent publication [15], the definition of IDH has come into question and was looked at more closely. Nadir-based definitions of IDH were more strongly associated with mortality rather than the change in intradialytic SBP (DiSBP), whereas previous studies [6,16,17] showed mixed associations with DiSBP and frequency of IDH with mortality. Intradialytic BP characteristics and changes are deserving of further research and emphasis given their importance in prognostication and implications on HD management.…”

Section: Introductionmentioning

confidence: 76%

See 1 more Smart Citation

Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients

Chou

Streja

Nguyen

et al. 2017

Nephrology Dialysis Transplantation

127

112

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Section: Introductionmentioning

confidence: 76%

“…IDH has been associated with cardiovascular morbidity and mortality [1][2][3], myocardial stunning [4,5], myocardial infarct [6], arrhythmias [6], vascular access thrombosis [7] and inadequate dialysis dose [8]. IDH has also been suggested to contribute to brain atrophy and white matter ischemia among HD patients [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients

Chou

Streja

Nguyen

et al. 2017

Nephrology Dialysis Transplantation

127

112

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“…This retention is quantified as interdialytic weight gain (IDWG). High IDWG is associated with hypertension (1), intradialytic hypotension (2), and adverse cardiovascular outcomes (3,4), including increased all-cause mortality (5). It is well accepted that the degree of IDWG is influenced by dietary sodium intake (6,7), and for this reason, guidelines suggest that individuals with CKD restrict dietary sodium intake (8,9).…”

Section: Introductionmentioning

confidence: 99%

Effect of Tenapanor on Interdialytic Weight Gain in Patients on Hemodialysis

Block

Rosenbaum

Leonsson-Zachrisson

et al. 2016

CJASN

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Background and objectives Interdialytic weight gain in patients on hemodialysis is associated with adverse cardiovascular outcomes and increased mortality. The degree of interdialytic weight gain is influenced by sodium intake. We evaluated the effects of tenapanor (AZD1722 and RDX5791), a minimally systemically available inhibitor of the sodium/hydrogen exchanger isoform 3, on interdialytic weight gain in patients with CKD stage 5D treated with hemodialysis.Design, setting, participants, & measurements This phase 2, randomized, double-blind study (NCT01764854; conducted January to September of 2013) enrolled adults on maintenance hemodialysis with interdialytic weight gain $3.0% of postdialysis weight and $2 kg. Patients were randomly assigned (1:1) to receive tenapanor or placebo. The primary end point was change in mean interdialytic weight gain (percentage of baseline postdialysis weight) from baseline (mean across a 2-week run-in period) to week 4. In a subgroup of inpatients, 24-hour stool sodium and stool weight were assessed for 1 week.Results Sixteen patients received 1 week of inpatient treatment (tenapanor, eight; placebo, eight), and 72 patients received 4 weeks of treatment in an outpatient setting (tenapanor, 37; placebo, 35; completers: tenapanor, 31; placebo, 33). In the outpatient cohort, no significant effect on interdialytic weight gain was detected; least squares mean changes in relative interdialytic weight gain from baseline to week 4 were tenapanor, 20.26% (95% confidence interval, 20.57% to 0.06%) and placebo, 20.23% (95% confidence interval, 20.54% to 0.07%; P=0.46). During week 1 (inpatient cohort only), compared with placebo, tenapanor treatment resulted in higher stool sodium content (mean [6SD]: tenapanor, 36.6 [621.8] mmol/d; placebo, 2.8 [62.7] mmol/d; P,0.001) and higher stool weight (tenapanor, 172.5 [668.1] g/d; placebo, 86.3 [630.0] g/d; P,0.01). A similar safety profile was observed across treatment groups with the exception of diarrhea, which occurred more frequently with tenapanor treatment.Conclusions Tenapanor treatment increased stool sodium and weight over placebo in patients undergoing hemodialysis. However, over 4 weeks of treatment, there was no difference in interdialytic weight gain between patients treated with tenapanor and those receiving placebo.

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“…Suboptimal fluid management leads to increased hospitalizations, patient discomfort, and substantial cost (1)(2)(3). However, evidence-based guidelines are currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Ultrafiltration Rates and the Quality Incentive Program: Proposed Measure Definitions and Their Potential Dialysis Facility Implications

Flythe

Assimon

Wenger

et al. 2016

CJASN

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Background and objectives Rapid ultrafiltration rates are associated with adverse outcomes among patients on hemodialysis. The Centers for Medicare and Medicaid Services is considering an ultrafiltration rate quality measure for the ESRD Quality Incentive Program. Two measure developers proposed ultrafiltration rate measures with different selection criteria and specifications. We aimed to compare the proposed ultrafiltration rate measures and quantify dialysis facility operational burden if treatment times were extended to lower ultrafiltration rates.Design, setting, participants, & measurements Data were taken from the 2012 database of a large dialysis organization. Analyses of the Centers for Medicare and Medicaid Services measure considered 148,950 patients on hemodialysis, and analyses of the Kidney Care Quality Alliance measure considered 151,937 patients. We described monthly patient and facility ultrafiltration rates and examined differences in patient characteristics across ultrafiltration rate thresholds and differences in facilities across ultrafiltration rate measure scores. We computed the additional treatment time required to lower ultrafiltration rates ,13 ml/h per kilogram.Results Ultrafiltration rates peaked in winter and nadired in summer. Patients with higher ultrafiltration rates were younger; more likely to be women, nonblack, Hispanic, and lighter in weight; and more likely to have histories of heart failure compared with patients with lower ultrafiltration rates. Facilities had, on average, 20.8% 610.3% (July) to 22.8%610.6% (February) of patients with ultrafiltration rates .13 ml/h per kilogram by the Centers for Medicare and Medicaid Services monthly measure. Facilities had, on average, 15.8%68.2% of patients with ultrafiltration rates $13 ml/h per kilogram by the Kidney Care Quality Alliance annual measure. Larger facilities (.100 patients) would require, on average, 33 additional treatment hours per week to lower all facility ultrafiltration rates ,13 ml/h per kilogram when total treatment time is capped at 4 hours.Conclusions Ultrafiltration rates vary seasonally and across clinical subgroups. Extension of treatment time as a strategy to lower ultrafiltration rates may pose facility operational challenges. Prospective studies of ultrafiltration rate threshold implementation are needed.

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Intradialytic Hypotension and Risk of Cardiovascular Disease

Cited by 257 publications

References 24 publications

Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients

Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients

Effect of Tenapanor on Interdialytic Weight Gain in Patients on Hemodialysis

Ultrafiltration Rates and the Quality Incentive Program: Proposed Measure Definitions and Their Potential Dialysis Facility Implications

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