Strategies for improving hemodynamic stability in cardiac-compromised dialysis patients

Sande, Frank M. van der; Kooman, Jeroen P.; Leunissen, Karel M.L.

doi:10.1016/s0272-6386(00)70284-8

Cited by 19 publications

(14 citation statements)

References 67 publications

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“…The biofeedback approach is based on the real-time and repeated measurement of physical/chemical signals coming from the patient, in order to control and modulate these variables gradually and smoothly along a predefined trajectory towards a predefined target. These new modalities, such as blood volume- [6][7][8][9] and blood temperature-controlled [10,11] hemodialysis, have demonstrated benefits in decreasing the intradialytic hypotension rate in chronic hemodialysis patients. Therefore, we have conducted a single-center, prospective, open-label, case-matched study to test the feasibility and safety of simultaneous blood volume and blood temperature online monitoring during hemodialysis sessions in critically ill patients with acute kidney injury (AKI).…”

Section: Introductionmentioning

confidence: 99%

Blood Volume- and Blood Temperature-Controlled Hemodialysis in Critically Ill Patients: A 6-Month, Case-Matched, Open-Label Study

et al. 2009

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Background/Aims: Online monitoring devices for intermittent hemodialysis have been developed to improve intradialytic cardiovascular stability in chronic dialysis patients. We propose to test blood volume and blood temperature biofeedback control systems in critically ill patients with acute kidney injury (AKI). Methods: Twenty patients were prospectively dialyzed with machines equipped with online monitoring new devices and compared with 42 historical controls. In addition to feasibility and safety appraisals, efficacy was assessed by the intradialytic hypotension rate. Results: During the study period, controlled temperature was assessed by a mean Δ_max body temperature of –0.3 ± 0.2°C, and all but 7% of dialysis sessions achieved relative blood volume-guided ultrafiltration profiling without increased dialysis-related complications. This was associated with decreased intradialytic hypotension rate. Conclusion: The combination of active controlled body temperature and profiled ultrafiltration by online monitoring systems is feasible and safe in critically ill AKI patients, and suggests possibilities for improvement in intradialytic hemodynamic stability.

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Section: Introductionmentioning

confidence: 99%

Blood Volume- and Blood Temperature-Controlled Hemodialysis in Critically Ill Patients: A 6-Month, Case-Matched, Open-Label Study

et al. 2009

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“…It is a major hindrance and has a negative impact on health-related quality of life in patients who are on the maintenance HD (2). Apart from patients' subjective discomforts, IHD often requires the early discontinuation of the dialysis session and/or the fluid replacement that results in chronic volume overload and underdialysis (3,4). Current guideline of the Dialysis Outcome Quality Initiative (DOQI) recommends that every effort be undertaken to minimize IHD that compromises the delivery of adequate dialysis (5).…”

mentioning

confidence: 99%

“…When it is combined with sodium profiles, UF profile can potentate the elevation of plasma tonicity, providing a greater driving force for plasma refilling by high UF rate during a high-sodium period. It can also avoid hypovolemia, reducing the incidence of hypotensive episodes by low UF rate during a low-sodium period (4,7,8). Therefore, the combination of UF profile has been a common practice during sodium profiling HD (4,8,17).…”

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confidence: 99%

Effect of Sodium Balance and the Combination of Ultrafiltration Profile during Sodium Profiling Hemodialysis on the Maintenance of the Quality of Dialysis and Sodium and Fluid Balances

Song¹,

Park²,

Lee³

et al. 2005

Journal of the American Society of Nephrology

116

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Excessive sodium gain is a major hindrance of sodium profiling hemodialysis (HD) that offsets the benefit in reducing intradialytic hypotension-related discomforts (IHD). Patients who showed frequent IHD (>30% of the sessions; n ‫؍‬ 11) were enrolled in a prospective study that consisted of two phases. In the phase 1 study, eight treatment modalities were evaluated: Conventional HD (control), sodium balance-positive step-down sodium profiling HD (PS), sodium balance-neutral stepdown sodium profiling HD (NS), sodium balance-neutral alternating sodium profiling HD (NA) without ultrafiltration (UF) profile, and all those with UF profile (UF only, PS؉U, NS؉U, and NA؉U). The incidences of "dialysis failure," defined as the occurrence of one or more of (1) session failure (discontinuation of session <75% of planned time), (2) UF failure (%UF achieved <70%), and (3) delivery failure (Kt/V <1.1), were 48.5, 21.2, 42.4, 39.4, 45.5, 18.2, 21.2, and 18.2% in control, PS, NS, NA, UF only, PS؉U, NS؉U, and NA؉U, respectively. Four treatments, PS, PS؉U, NS؉U, and NA؉U, reduced the incidence of dialysis failure significantly as compared with control (P < 0.05) and were evaluated in the phase 2 study, a randomized controlled 6-wk crossover study. Parameters were measured in the steady state after a 6-wk maintenance of each treatment. Diffusive sodium gain (⌬Na) was significantly increased with sodium balance-positive profiles with or without UF profile, PS and PS؉U (PS 1.9 ؎ 1.1, PS؉U 1.7 ؎ 1.0 mEq/L; both P < 0.05 to control ؊0.1 ؎ 0.2, NS؉U 0.5 ؎ 0.4, NA؉U 0.4 ؎ 0.2 mEq/L). They also increased the interdialytic weight gain (PS 3.8 ؎ 0.6, PS؉U 4.0 ؎ 0.6 kg; both P < 0.05 to control 2.7 ؎ 0.6, NS؉U 3.3 ؎ 0.6 kg; both P ‫؍‬ NS to NA؉U 3.5 ؎ 0.6 kg). Predialysis weight and the required amount of UF also increased significantly with these sodium balance-positive profiles. Although the absolute amount of UF was larger with PS and PS؉U, %UF achieved targeting dry weight was higher with sodium balance-neutral profiles with UF profiles, NS؉U and NA؉U (NS؉U 92.7 ؎ 3.8, NA؉U 93.7 ؎ 6.8%; both P < 0.05 to control 72.6 ؎ 14.0, PS 88.3 ؎ 6.6, PS؉U 88.2 ؎ 8.2%). Postdialysis weight was closest to dry weight with these treatments showing ⌬ (postdialysis weight ؊ dry weight) of 0.3 ؎ 0.1 and 0.3 ؎ 0.2 kg in NS؉U and NA؉U (both P < 0.05 to control 1.0 ؎ 0.6 kg; both P ‫؍‬ NS to PS 0.5 ؎ 0.3, PS؉U 0.5 ؎ 0.4 kg). Incidence of excessive weight gain and subjective discomforts during the interdialytic period increased significantly with PS. In conclusion, continuous use of sodium balance-positive sodium profiles resulted in an undesirable steady state with sodium and fluid expansion offsetting their hemodynamic benefit. Sodium balance-neutral sodium profiles in combination with UF profile were associated with less sodium and weight gains, better UF performance with postdialysis weight closest to dry weight, and fewer interdialytic problems with the equivalent hemodynamic benefit. Therefore, it is proposed that sodium balance-neutral sodium profiling...

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“…IDH is an important clinical problem because associated symptoms, such as nausea and cramps, have a negative impact on health-related quality of life (2). In addition, IDH often requires the administration of fluids (3) or the early discontinuation of dialysis, both of which may prevent adequate fluid removal (3,4). Patients with IDH may ultimately experience the effects of volume overload and chronic underdialysis (5).…”

mentioning

confidence: 99%

A Randomized, Controlled Trial of Albumin versus Saline for the Treatment of Intradialytic Hypotension

Knoll¹,

Grabowski²,

Dervin³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Intradialytic hypotension (IDH) is the most common complication of hemodialysis. Symptomatic IDH requires the administration of fluid and often results in the early termination of dialysis, both of which may prevent adequate fluid removal. The optimal fluid for the treatment of IDH remains unknown. A randomized, double-blind, crossover trial was performed in 72 chronic hemodialysis patients to determine whether 5% albumin was more effective than normal saline for the treatment of IDH. The primary outcome measure was the percentage of target ultrafiltration achieved, which was defined as the actual ultrafiltration volume divided by target ultrafiltration volume. Secondary outcome measures included postdialysis BP, time to restore BP, recurrent IDH, and treatment failure (inability to restore BP with 750 ml of study fluid). The percentage of target ultrafiltration achieved was 0.84 Ϯ 0.17 for 5% albumin compared with 0.80 Ϯ 0.16 for saline (P ϭ 0.14). The postdialysis systolic BP (121 Ϯ 19 mmHg versus 117 Ϯ 19 mmHg; P ϭ 0.32), postdialysis diastolic BP (63 Ϯ 9 mmHg versus 61 Ϯ 9 mmHg; P ϭ 0.33), volume of study fluid used to treat IDH (403 Ϯ 170 ml versus 428 Ϯ 191 ml; P ϭ 0.34), time required to restore the BP (7.9 Ϯ 6.6 min versus 9.9 Ϯ 7.5 min; P ϭ 0.09), total nursing time required to manage the hypotensive episode (15.1 Ϯ 7.2 min versus 15.9 Ϯ 7.3 min; P ϭ 0.47), number of treatment failures (22% versus 24%; P ϭ 1.0), and the frequency of recurrent IDH (36% versus 36%) were not significantly different when 5% albumin was used compared with saline. It is concluded that 5% albumin is no more effective than normal saline for the treatment of IDH in chronic hemodialysis patients. Normal saline should be used as the initial fluid for the treatment of IDH.

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Strategies for improving hemodynamic stability in cardiac-compromised dialysis patients

Cited by 19 publications

References 67 publications

Blood Volume- and Blood Temperature-Controlled Hemodialysis in Critically Ill Patients: A 6-Month, Case-Matched, Open-Label Study

Blood Volume- and Blood Temperature-Controlled Hemodialysis in Critically Ill Patients: A 6-Month, Case-Matched, Open-Label Study

Effect of Sodium Balance and the Combination of Ultrafiltration Profile during Sodium Profiling Hemodialysis on the Maintenance of the Quality of Dialysis and Sodium and Fluid Balances

A Randomized, Controlled Trial of Albumin versus Saline for the Treatment of Intradialytic Hypotension

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