Postprandial Blood Pressure Changes During Hemodialysis

Sherman, Richard A.; Torres, Francisco; Cody, Ronald P.

doi:10.1016/s0272-6386(88)80069-6

Cited by 57 publications

(42 citation statements)

References 13 publications

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“…Patients with autonomic dysfunction are particularly prone to hypotension after meals. All of these factors predispose to IDH, which Sherman et al (15) showed in a prospective controlled trial of 125 hemodialysis treatments in nine nondiabetic patients. Mean BP fell by 14.4 mmHg/h 45 minutes after a meal consumed between 1.5 and 2 hours after the start of dialysis versus 2.2 mmHg/h in the control period.…”

Section: Treatmentmentioning

confidence: 94%

Attending Rounds

Reilly

2014

Clinical Journal of the American Society of Nephrology

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Intradialytic hypotension is the most common adverse event that occurs during the hemodialysis procedure. Despite advances in machine technology, it remains a difficult management issue. The pathophysiology of intradialytic hypotension and measures to reduce its frequency are discussed. An accurate assessment of dry weight is crucial in all patients on dialysis and especially those patients prone to intradialytic hypotension. The presence of edema and hypertension has recently been shown to be a poor predictor of volume overload. Noninvasive methods to assess volume status, such as whole body and segmental bioimpedance, hold promise to more accurately assess fluid status. Reducing salt intake is key to limiting interdialytic weight gain. A common problem is that patients are often told to restrict fluid but not salt intake. Lowering the dialysate temperature, prohibiting food ingestion during hemodialysis, and midodrine administration are beneficial. Sodium modeling in the absence of ultrafiltration modeling should be abandoned. There is not enough data on the efficacy of L-carnitine to warrant its routine use.Clin J Am Soc Nephrol 9: 798-803, 2014. doi: 10.2215/CJN.09930913 Case PresentationA 65-year-old man was on hemodialysis since 2006 as a result of long-standing type II diabetes mellitus.Other medical problems included hypertension, hyperthyroidism treated with total thyroidectomy, history of subtotal parathyroidectomy, sickle cell trait, gastroesophageal reflux disease, severe peripheral vascular disease, coronary artery disease, moderate concentric left ventricular hypertrophy (LVH), and diabetic retinopathy. His medications were metoprolol, lisinopril, gabapentin, cinacalcet, calcium acetate, lanthanum carbonate, levothyroxine, and omeprazole. On physical examination, lungs were clear to auscultation, cardiac rhythm was regular, an S4 was audible, no edema was present, and there was a brachiobasilic fistula in the left arm. Relevant laboratory studies included sodium5139 mEq/L, potassium54.6 mEq/L, calcium 8.95mg/dl, phosphorus56.5 mg/dl, parathyroid hormone5558 pg/ml, albumin53.4 g/dl, and hemoglobin511.5 g/dl. Dialysis duration was 4 hours. Dialysate composition was 2.0 mEq/L potassium and 2.5 mEq/L calcium with a citrate, and not acetate-based, acid concentrate. The single pool Kt/V on this prescription was 1.49. His average interdialytic weight gain was 4 kg per treatment, and his dry weight was 98.5 kg.During a chronic outpatient dialysis session, he developed intradialytic hypotension (IDH). BPs during the treatment are shown in Table 1 (treatment 1). His predialysis temperature was 36.2°C. At the BP indicated in Table 1, he felt poorly and was diaphoretic. In response, saline was administered, ultrafiltration was stopped, and the patient was placed in a reclining position with resolution of the hypotension. He had a previous history of IDH and as a result, was already being dialyzed with cool dialysate (temperature535.5°C) and ultrafiltration modeling. Given the apparent absence of signs ...

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Section: Treatmentmentioning

confidence: 94%

Attending Rounds

Reilly

2014

Clinical Journal of the American Society of Nephrology

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“…An osmotic fluid shift into the gut and hence the reduction in intravascular volume may also contribute to food-induced hypotension. Symptomatic post-prandial hypotension is also common in HD patients [2] . In spite of concerns about its potential detrimental effects on haemodynamic stability, advice about eating immediately before or during an HD session is inconsistent, and practice varies.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic Effects of Food Intake during Haemodialysis

Sivalingam

Banerjee²,

Nevett³

et al. 2008

Blood Purif

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Background: There is some doubt whether food intake during haemodialysis (HD) is detrimental to haemodynamic stability. Methods: We studied 20 stable non-diabetic HD patients during a single session. A standard meal was given 45 min into dialysis. Relative blood volume (RBV), cardiac output (CO), systemic vascular resistance (SVR) and extracellular fluid (ECF) resistance were monitored continuously. Total protein and albumin were measured. Results: There was a significant reduction in RBV after food ingestion (maximum reduction 3.4 ± 1.1%; p < 0.001). There was no significant change in ECF resistance, heart rate, CO or SVR. Mean arterial pressure was significantly different from pre-food levels 30 min after food (p = 0.04). The rate of change of total protein and albumin concentration was significantly higher immediately after food ingestion. Conclusions: Food intake during HD caused significant reductions in RBV, possibly related to fluid shifts from intestinal microcirculation to interstitium. CO and SVR remained stable perhaps because of the opposing effects of food ingestion and UF.

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“…As dialysis became more efficient, treatment times were shortened, and with more rapid volume and solute removal, hemodynamic instability became a challenge (3). Importantly, hypotension seemed to be more common among patients who had recently eaten, and additional investigation identified a postprandial fall in systemic vascular resistance as the most likely mechanism (4,5). Although there are no case reports of aspiration from eating on dialysis, newspaper articles do show a few such lawsuits (6).…”

mentioning

confidence: 99%

Peanuts or Pretzels? Changing Attitudes about Eating on Hemodialysis

Franch

2016

CJASN

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Postprandial Blood Pressure Changes During Hemodialysis

Cited by 57 publications

References 13 publications

Attending Rounds

Attending Rounds

Haemodynamic Effects of Food Intake during Haemodialysis

Peanuts or Pretzels? Changing Attitudes about Eating on Hemodialysis

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