Techniques to improve intradialytic haemodynamic stability

Gullapudi, V R Latha; Kazmi, Isma; Selby, Nicholas M.

doi:10.1097/mnh.0000000000000449

Cited by 12 publications

(8 citation statements)

References 36 publications

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“…IDH is a critical complication associated with the increased mortality in patients with ESRD on hemodialysis 1,2 . These observations have encouraged several studies on preventing IDH 22–25 . Increasing dialysis time and/or frequency could help prevent IDH 26 .…”

Section: Discussionmentioning

confidence: 97%

Predicting intradialytic hypotension using heart rate variability

Park

Kim

Cho

et al. 2019

Sci Rep

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This study aimed to identify whether a new method using heart rate variability (HRV) could predict intradialytic hypotension (IDH) for one month in advance for patients undergoing prevalent hemodialysis. A total 71 patients were enrolled, and baseline clinical characteristics and laboratory results were collected when HRV was measured, then, the frequency of IDH was collected during the observation period. HRV parameters included heart rate, R-R interval, the standard deviation of N-N interval, the square root of the mean squared differences of successive NN intervals, very low frequency, low frequency, high frequency, total power, and low frequency/high frequency ratio. During the one-month observation period, 28 patients experienced 85 cases of IDH (10.0% of a total 852 dialysis sessions). Among the clinical and laboratory parameters, ultrafiltration rate, prior history of diabetes, coronary artery disease, or congestive heart failure, age, intact parathyroid hormone level, and history of antihypertensive drug use were integrated into the multivariate model, referred to as a basic model, which showed significant ability to predict IDH (the area-under-curve [AUC], 0.726; p = 0.002). In HRV parameters, changes between the early and middle phases of hemodialysis (referred to Δ) were identified as significant independent variables. New models were built from the combination of Δ values with the basic model. Among them, a model with the highest AUC value (AUC, 804; p < 0.001) was compared to the basic model and demonstrated improved performance when HRV parameters were used ( p = 0.049). Based on our results, it is possible that future IDH might be predicted more accurately using HRV.

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Section: Discussionmentioning

confidence: 97%

Predicting intradialytic hypotension using heart rate variability

Park

Kim

Cho

et al. 2019

Sci Rep

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“…IDH and myocardial ischemia are frequent complications of hemodialysis 5 . IDH may result from a failure to tolerate ultra ltration leading to an imbalance between central hypovolemia and re ex-mediated hemodynamic responses 6 , and is clearly associated with adverse outcomes [7][8][9] , and all-cause mortality 7 .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Predialysis Systolic Blood Pressure Variability and Intradialytic Cardiac Hemodynamics in Hemodialysis Patients

Yang

Huang

et al. 2020

Preprint

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The association in hemodialysis patients between long-term predialysis blood pressure variability and intradialytic cardiac hemodynamics was assessed prospectively in 1070 patients receiving maintenance hemodialysis for more than 3 months. Predialysis blood pressure variability was assessed over 1-year intervals. Outcomes included factors were intradialytic hypotension and change in rate-pressure product. The final cohort’s mean age was 59 years, and 57% were males. Greater predialysis systolic blood pressure variability was associated with an increased risk of intradialytic hypotension (adjusted hazard ratio, 1.097; 95% confidence intervals 1.055 to 1.140) and change in rate-pressure product (adjusted hazard ratio, 1.213; 95% confidence intervals 1.163 to 1.265). Results were similar when blood pressure variability was stratified by baseline systolic blood pressure. Factors associated with higher systolic blood pressure variability were older age, female sex, longer duration of dialysis, and diagnosis of diabetic nephropathy, and lower levels of serum albumin. In conclusion, greater predialysis systolic blood pressure variability among hemodialysis patients was associated with greater intradialytic cardiac hemodynamic instability. Strategies to reduce blood pressure variability might be beneficial for hemodialysis patients.

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“…Another side effect of hemodialysis that a patient may experience during dialysis is nausea and vomiting, which may cause stress and anxiety to the patient and, on the other hand, can lead to early cessation of dialysis, which is undesirable, and the adequacy of dialysis can be affected. In the majority of cases, nausea and vomiting are associated with a decrease in blood pressure [ 29 ]. The main reasons for HD complications can be divided into results from common dialysis methods, mechanical, and the advent of continuous or incomplete purification of toxins which directly affect the quality of treatment.…”

Section: Intradialytic Complicationsmentioning

confidence: 99%

Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications

Karimi

Dideban

Heidari

2022

Journal of Healthcare Engineering

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Acute kidney failure patients while detoxificated by hemodialysis (HD) mostly or continuously faced regular problems such as low blood pressure (hypotension), muscle cramps, nausea, or vomiting. Higher intradialytic symptom leads to low-quality HD treatment. Although more known therapeutic interventions are used to relieve the HD side effects, this study was designed to investigate how intelligent systems can make highly beneficial alterations in dialysis facilities and equipment to ease intradialytic complications and help the staff deliver high-quality treatment. A search was performed among relevant research articles based on nonpharmacological intervention methods considered to prevent adverse effects of renal replacement therapy until 2020 in the PubMed databases using the terms “intradialytic complications,” “intradialytic complication interventions,” “nonpharmacological interventions,” “intradialytic exercises,” and “adequacy calculation methods.” Studies included the prevalence of intradialytic complications, different strategies with the aim of preventing complications, the outcome of intradialytic exercises on dialysis symptoms, and dialysis dose calculation methods. The results showed the incidence of hypotension varying between 5% and 30%, fatigue, muscular cramps, and vomiting as the most common complications during dialysis, which greatly affect the outcome of HD sessions. To prevent hypotension, ultrafiltration profiling, sodium modeling, low dialysate temperature, and changing the position to Trendelenburg are some strategies. Urea reduction ratio (URR), formal urea kinetic modeling (FUKM), formal single-pool urea kinetics, and online clearance monitoring (OCM) are methods for calculating the delivered dose of dialysis in which OCM is a low-cost and accessible way to monitor regularly the quality of dialysis delivered. Integration of the chair and HD machine which is in direct contact with the patient provides an intelligent system that improves the management of the dialysis session to enhance the quality of healthcare service.

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Techniques to improve intradialytic haemodynamic stability

Abstract: IDH remains a significant clinical problem. Recent evidence from the last 2 years does not support any major changes to current practice, with cooling of the dialysate and reduction of IDWG remaining cornerstones of management.

Cited by 12 publications

References 36 publications

Predicting intradialytic hypotension using heart rate variability

Predicting intradialytic hypotension using heart rate variability

Long-Term Predialysis Systolic Blood Pressure Variability and Intradialytic Cardiac Hemodynamics in Hemodialysis Patients

Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications

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