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Intradialytic hypotension

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https://www.readbyqxmd.com/read/27833921/management-of-patient-care-in-hemodialysis-while-focusing-on-cardiovascular-disease-events-and-the-atypical-role-of-hyper-and-or-hypotension-a-systematic-review
#1
REVIEW
Amjad Khan, Amer Hayat Khan, Azreen Syazril Adnan, Syed Azhar Syed Sulaiman, Siew Hua Gan, Irfanullah Khan
Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27773426/peritoneal-or-hemodialysis-for-the-frail-elderly-patient-the-choice-of-2-evils
#2
Edwina A Brown, Frederic O Finkelstein, Osasuyi U Iyasere, Alan S Kliger
Management of older people on dialysis requires focus on the wider aspects of aging as well as dialysis. Almost all frail and older patients receiving dialysis will default to in-center hemodialysis, although the availability of assisted peritoneal dialysis enables dialysis at home. As with any disease management decision, patients approaching end-stage renal disease need all the appropriate facts about their prognosis, the natural history of their disease without dialysis, and the resulting outcomes and complications of the different dialysis modalities...
October 20, 2016: Kidney International
https://www.readbyqxmd.com/read/27772642/intensive-hemodialysis-and-treatment-complications-and%C3%A2-tolerability
#3
Jose A Morfin, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Peter A McCullough, Paul Komenda
Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90mmHg and intradialytic decline > 30mmHg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27761981/dialysate-bicarbonate-variation-in-maintenance-hemodiafiltration-patients-impact-on-serum-bicarbonate-intradialytic-hypotension-and-interdialytic-weight-gain
#4
Márcio Viegas, Cristina Cândido, Joana Felgueiras, José Clemente, Sara Barros, Rostislav Farbota, Filipa Vera, Antero Matos, Francisco Sousa
Introduction The dialysate bicarbonate (DB) influences the acid-base balance in dialysis patients. Very low and high serum bicarbonate (SB) have been related with a higher mortality. Acid-base balance also has been associated with hemodynamic effects in these patients. The trial aim was to compare the effect of DB concentration variation on SB levels in maintenance hemodiafiltration (HDF) patients and the effect on intradialytic hypotension and interdialytic weight gain. Methods  A prospective study, with 9 months of follow-up, involving 93 patients, divided in two groups: group 1 and group 2 with a DB of 34 mmol/L and 30 mmol/L, respectively, with monitoring of pre and post HDF SB, intradialytic hypotension, and interdialytic weight gain...
October 20, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27754086/os-19-09-bioelectrical-impedance-phase-angle-as-intradialytic-hypotension-predictor
#5
Vaidas Vicka, Laurynas Rimsevicius, Alvita Gincaite, Diana Sukackiene, Marius Miglinas
OBJECTIVE: Water balance and blood pressure (BP) alterations are strongly associated in haemodialysis (HD) patients. Aim of this study was to determine whether bioelectrical impedance analysis (BIA) parameters can be used as predictors of intradialytic hypotension (IDH). DESIGN AND METHOD: We conducted an observational study of chronic HD patients. BIA was measured before the HD procedure using InBody S10 (Biospace, Seoul, Korea) body composition analyzer. Intracellular water (ICW), extracellular water (ECW), total body water (TBW), ECW/TBW ratio and phase angle (PhA) were selected as markers of hydration state and thus possible predictors of IDH...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643011/os-19-09-bioelectrical-impedance-phase-angle-as-intradialytic-hypotension-predictor
#6
Vaidas Vicka, Laurynas Rimsevicius, Alvita Gincaite, Diana Sukackiene, Marius Miglinas
OBJECTIVE: Water balance and blood pressure (BP) alterations are strongly associated in haemodialysis (HD) patients. Aim of this study was to determine whether bioelectrical impedance analysis (BIA) parameters can be used as predictors of intradialytic hypotension (IDH). DESIGN AND METHOD: We conducted an observational study of chronic HD patients. BIA was measured before the HD procedure using InBody S10 (Biospace, Seoul, Korea) body composition analyzer. Intracellular water (ICW), extracellular water (ECW), total body water (TBW), ECW/TBW ratio and phase angle (PhA) were selected as markers of hydration state and thus possible predictors of IDH...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642391/-intradialytic-arterial-hypotension-in-a-patient-on-chronic-hemodialysis-revealing-ante-hypophyseal-insufficiency
#7
Jaouad El Maghraoui, Hanane Ouahabi, Nadia Kabbali, Mohamed Arrayhani, Farida Ajdi, Tariq Sqalli Houssaini
No abstract text is available yet for this article.
2016: Pan African Medical Journal
https://www.readbyqxmd.com/read/27615278/a-meta-analysis-of-sodium-profiling-techniques-and-the-impact-on-intradialytic-hypotension
#8
Nina Dunne
Introduction Hemodialysis has improved in recent years, however, despite such improvements, intra-dialytic hypotensive episodes still persist which can lead to a reduction in the overall effectiveness of the treatment. Profiling sodium levels during dialysis can improve vascular refilling and therefore may prevent hypotensive events. A number of profiling methods exist and this meta-analysis set out to examine the effectiveness of these methods. Methods To assess the effectiveness of hemodialysis sodium profiling techniques...
September 12, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27606498/intradialytic-hypotension
#9
Ambreen Gul, Dana Miskulin, Antonia Harford, Philip Zager
PURPOSE OF REVIEW: This review focuses on recent advances in our understanding of intradialytic hypotension (IDH) and measures that may reduce its frequency. RECENT FINDINGS: The frequency and severity of IDH predict the risk for adverse clinical outcomes. The highest mortality risks associated with IDH were observed when the intradialytic systolic blood pressure (SBP) nadirs were <90 and <100 mmHg and the predialysis SBP were ≤159 mmHg or ≥160 mmHg, respectively...
November 2016: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27572624/intra-dialytic-blood-oxygen-saturation-so2-association-with-dialysis-hypotension-the-soglia-study
#10
E Mancini, C Perazzini, L Gesualdo, F Aucella, A Limido, F Scolari, S Savoldi, M Tramonti, L Corazza, M Atti, S Severi, P Bolasco, A Santoro
BACKGROUND: Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO2) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. AIM: To evaluate whether short- and medium-term variations in the SO2 signal (ST-SO2var, MT-SO2var,) during dialysis are a predictor of IDH...
August 29, 2016: Journal of Nephrology
https://www.readbyqxmd.com/read/27556272/an-update-on-intradialytic-cardiac-dysfunction
#11
Aghogho Odudu, Christopher W McIntyre
Cardiac dysfunction is a key factor in the high morbidity and mortality rates seen in hemodialysis (HD) patients. Much of the dysfunction is manifest as adverse changes in cardiac and vascular structure prior to commencing dialysis. This adverse vascular remodeling arises as a dysregulation between pro- and antiproliferative signaling pathways in response to hemodynamic and nonhemodynamic factors. The HD procedure itself further promotes cardiomyopathy by inducing hypotension and episodic regional cardiac ischemia that precedes global dysfunction, fibrosis, worsening symptoms, and increased mortality...
November 2016: Seminars in Dialysis
https://www.readbyqxmd.com/read/27553912/faster-rate-of-blood-volume-change-in-pediatric-hemodialysis-patients-impairs-cardiac-index
#12
Jessica J Geer, Shweta Shah, Eric Williams, Ayse Akcan Arikan, Poyyapakkam Srivaths
BACKGROUND: Intradialytic hypotension and myocardial stunning are proposed as contributing to the pathogenesis of increased cardiovascular disease burden and death in patients receiving maintenance hemodialysis (HD). Noninvasive cardiac output measurements provide a dynamic, real-time assessment of hemodynamic parameters. We investigated intradialytic changes in hemodynamic parameters in pediatric outpatients receiving chronic HD and determined patient and treatment risk factors associated with such intradialytic changes...
August 23, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27539225/measurement-of-cardiac-output-and-blood-volume-during-hemodialysis-with-fluorescent-dye-dilution-technique
#13
Jean Michel I Maarek, Eduardo H Rubinstein, Yumei Guo, Christianne J Lane, Vito M Campese, Daniel P Holschneider
Intradialytic hypotensive events (IDH) accompanied by deleterious decreases of the cardiac output complicate up to 25% of hemodialysis treatments. Monitoring options available to track hemodynamic changes during hemodialysis have been found ineffective to anticipate the occurrence of IDH. We have assembled opto-electronic instrumentation that uses the fluorescence of a small bolus of indocyanine green dye injected in the hemodialysis circuit to estimate cardiac output and blood volume based on indicator dilution principles in patients receiving hemodialysis...
August 18, 2016: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/27528100/sources-of-mortality-on-dialysis-with-an-emphasis-on-microemboli
#14
Bernd G Stegmayr
Patients on chronic hemodialysis have a shortened survival compared to the general population. There are multiple sources of morbidity and mortality unique to the dialysis population that account for this. Reasons include the effects of blood membrane interactions, intradialytic hypotension, myocardial stunning, excessive interdialytic weight gain, high-flow arteriovenous fistulae, and impaired lipid break down by anticoagulation administered during HD. Another risk factor, not well appreciated, is the occurrence of microemboli of air (microbubbles) during HD...
November 2016: Seminars in Dialysis
https://www.readbyqxmd.com/read/27277830/hypotension-and-hypovolemia-during-hemodialysis-is-the-usual-suspect-innocent
#15
David Berger, Jukka Takala
Hypotension during intermittent hemodialysis is common, and has been attributed to acute volume shifts, shifts in osmolarity, electrolyte imbalance, temperature changes, altered vasoregulation, and sheer hypovolemia. Although hypovolemia may intuitively seem a likely cause for hypotension in intensive care patients, its role in the pathogenesis of intradialytic hypotension may be overestimated.
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27226133/the-heart-and-vascular-system-in-dialysis
#16
REVIEW
Christoph Wanner, Kerstin Amann, Tetsuo Shoji
The heart and the vascular tree undergo major structural and functional changes when kidney function declines and renal replacement therapy is required. The many cardiovascular risk factors and adaptive changes the heart undergoes include left ventricular hypertrophy and dilatation with concomitant systolic and diastolic dysfunction. Myocardial fibrosis is the consequence of impaired angio-adaptation, reduced capillary angiogenesis, myocyte-capillary mismatch, and myocardial micro-arteriopathy. The vascular tree can be affected by both atherosclerosis and arteriosclerosis with both lipid rich plaques and abundant media calcification...
July 16, 2016: Lancet
https://www.readbyqxmd.com/read/27207178/the-passive-leg-raising-test-to-guide-fluid-removal-in-critically-ill-patients
#17
Xavier Monnet, Flora Cipriani, Laurent Camous, Pierre Sentenac, Martin Dres, Evguenia Krastinova, Nadia Anguel, Christian Richard, Jean-Louis Teboul
BACKGROUND: To investigate whether haemodynamic intolerance to fluid removal during intermittent renal replacement therapy (RRT) in critically ill patients can be predicted by a passive leg raising (PLR) test performed before RRT. METHODS: We included 39 patients where intermittent RRT with weight loss was decided. Intradialytic hypotension was defined as hypotension requiring a therapeutic intervention, as decided by the physicians in charge. Before RRT, the maximal increase in cardiac index (CI, pulse contour analysis) induced by a PLR test was recorded...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27190374/impact-of-using-two-dialyzers-in-parallel-on-phosphate-clearance-in-hemodialysis-patients-a-randomized-trial
#18
Stephanie Thompson, Braden Manns, Anita Lloyd, Brenda Hemmelgarn, Jennifer MacRae, Scott Klarenbach, Larry Unsworth, Mark Courtney, Marcello Tonelli
BACKGROUND: Dietary restriction and phosphate binders are the main interventions used to manage hyperphosphatemia in people on hemodialysis, but have limited efficacy. Modifying conventional dialysis regimens to enhance phosphate clearance as an alternative approach remains relatively unstudied. METHODS: This was a 10-week, 2-arm, randomized crossover study. Participants were prevalent dialysis patients (n = 32) with consecutive serum phosphate levels >1.6 mmol/L and on stable doses of a phosphate binder...
April 21, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27183451/vascular-calcification-and-intradialytic-hypotension-in-hemodialysis-patients-clinical-relevance-and-impact-on-morbidity-and-mortality
#19
Se Young Kim, Yu Ah Hong, Hye Eun Yoon, Yoon Kyung Chang, Chul Woo Yang, Suk Young Kim, Hyeon Seok Hwang
BACKGROUND: Vascular calcification (VC) and intradialytic hypotension (IDH) indicate morphological and functional disorders of the cardiovascular system in hemodialysis (HD) patients. However, their relationship and combined effects on clinical outcomes remain undetermined. METHODS: HD patients (n=443) whose plain chest radiographs were examined for aortic arch VC were included. IDH was defined as nadir systolic blood pressure <90mmHg or need for bolus fluid...
August 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27182000/preservation-of-residual-kidney-function-in-hemodialysis-patients-reviving-an-old-concept
#20
REVIEW
Anna T Mathew, Steven Fishbane, Yoshitsugu Obi, Kamyar Kalantar-Zadeh
Residual kidney function (RKF) may confer a variety of benefits to patients on maintenance dialysis. RKF provides continuous clearance of middle molecules and protein-bound solutes. Whereas the definition of RKF varies across studies, interdialytic urine volume may emerge as a pragmatic alternative to more cumbersome calculations. RKF preservation is associated with better patient outcomes including survival and quality of life and is a clinical parameter and research focus in peritoneal dialysis. We propose the following practical considerations to preserve RKF, especially in newly transitioned (incident) hemodialysis patients: (1) periodic monitoring of RKF in hemodialysis patients through urine volume and including residual urea clearance with dialysis adequacy and outcome markers such as anemia, fluid gains, minerals and electrolytes, nutritional, status and quality of life; (2) avoidance of nephrotoxic agents such as radiocontrast dye, nonsteroidal anti-inflammatory drugs, and aminoglycosides; (3) more rigorous hypertension control and minimizing intradialytic hypotensive episodes; (4) individualizing the initial dialysis prescription with consideration of an incremental/infrequent approach to hemodialysis initiation (e...
August 2016: Kidney International
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