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Intradialytic hypotension

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https://www.readbyqxmd.com/read/29682559/hemodynamic-instability-during-dialysis-the-potential-role-of-intradialytic-exercise
#1
REVIEW
Scott McGuire, Elizabeth Jane Horton, Derek Renshaw, Alofonso Jimenez, Nithya Krishnan, Gordon McGregor
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intradialytic hypotension (IDH) can be as high as 20-30%, contributing to subclinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodeling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are suboptimal...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29675862/hemodialysis-a-model-for-extreme-physiology-in-a-vulnerable-patient-population
#2
REVIEW
Jeroen P Kooman, Krassimir Katzarski, Frank M van der Sande, Karel M Leunissen, Peter Kotanko
Hemodialysis (HD) is a lifesaving treatment for patients with end-stage renal disease, which is very efficient in the correction of abnormalities of the internal environment. However, this efficiency also induces significant hemodynamic, thermal, and respiratory stressors. These have parallels with the extreme physiologic demands which are normally mainly experienced by healthy subjects under adverse environmental conditions, with the difference that they must be endured by a vulnerable patient population. Hemodynamic stress induced by ultrafiltration leads to a decline in circulating blood volume, which may result in intradialytic hypotension (IDH) and changes in tissue perfusion, which may have long-term consequences for the function of vital organs such as the brain and the heart...
April 19, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29669016/hemodynamic-response-to-fluid-removal-during-hemodialysis-categorization-of-causes-of-intradialytic-hypotension
#3
Nathan W Levin, Marcia H F G de Abreu, Lucas E Borges, Helcio A Tavares Filho, Rabia Sarwar, Surendra Gupta, Tahir Hafeez, Shaul Lev, Caroline Williams
Background: Intradialytic hypotension is a clinically significant problem, however, the hemodynamics that underlie ultrafiltration and consequent hypotensive episodes has not been studied comprehensively. Methods: Intradialytic cardiac output, cardiac power and peripheral resistance changes from pretreatment measurements were evaluated using a novel regional impedance cardiographic device (NICaS, NI Medical, Peta Tikva, Israel) in 263 hemodialysis sessions in 54 patients in dialysis units in the USA and Brazil with the goal of determining the various hemodynamic trends as blood pressure decreases...
April 14, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29657203/the-development-of-malnutrition-is-not-dependent-on-its-traditional-contributing-factors-in-patients-on-maintenance-hemodialysis-in-developing-countries
#4
Syed Rizwan Ali Bokhari, Mirza Ameer Faizan Ali, Syed Arsalan Khalid, Bushra Iftikhar, Hafiz Ijaz Ahmad, Ahlam Safdar Hussain, Usman Yaqoob
Malnutrition in dialysis population is associated with significant morbidity and mortality. Nutritional assessment is a neglected area in hemodialysis (HD) patients in developing countries. The aim of the study was to find out whether any traditional parameters have statistically significant correlation with malnutrition. All 58 end-stage renal disease patients on maintenance HD in our dialysis unit were enrolled in this cross-sectional study. The nutritional status was assessed by a predesigned questionnaire including subjective global assessment (SGA)...
March 2018: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/29629281/use-of-fludrocortisone-for-intradialytic-hypotension
#5
Yuri Seo, Soomin Jeung, Sun-Myoung Kang, Won Seok Yang, Hyosang Kim, Soon Bae Kim
Intradialytic hypotension during dialysis adversely affects a patient's prognosis and increases mortality. We report a case in which intradialytic hypotension that persisted after the administration of midodrine was relieved after the use of fludrocortisone. Administration of 0.2 mg of fludrocortisone occurred 30 minutes before dialysis. We compared 45 sessions of dialysis without fludrocortisone administration and 45 sessions of dialysis with fludrocortisone administration in one patient. The number of times in which systolic blood pressure became lower than 80 mmHg and the number of early terminations of dialysis due to a decrease in systolic blood pressure were higher in the sessions without fludrocortisone administration than in the sessions with fludrocortisone administration ( P < 0...
March 2018: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/29624853/impact-of-salt-reduction-in-meals-consumed-during-hemodialysis-sessions-on-interdialytic-weight-gain-and-hemodynamic-stability
#6
Arthur Colson, Anita Brinkley, Philippe Braconnier, Nadia Ammor, Michel Burnier, Menno Pruijm
INTRODUCTION: Patients on hemodialysis (HD) are advised to limit daily water- and salt intake to reduce interdialytic weight gain (IDWG). To counterbalance protein-losses, protein-rich meals are sometimes provided during HD sessions, but their salt content is not always taken into account. The aim of this study was to assess the influence of a lower salt content of meals provided during HD sessions on IDWG, blood pressure (BP), and hemodynamic stability during dialysis. METHODS: This monocentric, interventional study was proposed to all the patients treated with three weekly HD sessions...
April 6, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29614972/aortic-stenosis-is-a-risk-factor-for-all-cause-mortality-in-patients-on-dialysis-a-multicenter-prospective-cohort-analysis
#7
Daijo Inaguma, Yuji Sasakawa, Noriko Suzuki, Eri Ito, Kazuo Takahashi, Hiroki Hayashi, Shigehisa Koide, Midori Hasegawa, Yukio Yuzawa
BACKGROUND: Aortic stenosis (AS) is common in patients on dialysis as well as in the general population. AS leads to difficulty with dialysis therapy because of unstable conditions such as intradialytic hypotension due to low cardiac output. However, the precise morbidity rates and risk factors of AS in patients on dialysis are unknown. Moreover, there are no large-scale observational studies regarding the association between AS in patients on dialysis and mortality. Therefore, we will investigate whether morbidity of AS in patients on dialysis is associated with mortality...
April 3, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29581966/impaired-gut-epithelial-tight-junction-expression-in-hemodialysis-patients-complicated-with-intradialytic-hypotension
#8
Tsai-Kun Wu, Paik-Seong Lim, Jong-Shiaw Jin, Ming-Ying Wu, Chang-Hsu Chen
Background: There is accumulating evidence pointing to uremia-induced impairment of the intestinal epithelial barrier structure in advanced chronic kidney disease (CKD) and hemodialysis (HD) patients. In this study, the impact of intradialytic hypotension on intestinal barrier integrity is being explored. Methods: Immunohistochemical staining was used to detect the expression of 4 types of tight junction (TJ) proteins such as occludin, zonula occludens-1 (ZO-1), claudin-1, and claudin-4, in colonic samples of a group of patients receiving segmental colectomy...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29511057/hemodiafiltration-to-address-unmet-medical-needs-eskd-patients
#9
Bernard Canaud, Jörg Vienken, Stephen Ash, Richard A Ward
Hemodiafiltration combines diffusive and convective solute removal in a single therapy by ultrafiltering 20% or more of the blood volume processed using a high-flux hemodialyzer and maintaining fluid balance by infusing sterile nonpyrogenic replacement fluid directly into the patient's blood. In online hemodiafiltration, the large volumes of replacement fluid required are obtained by online filtration of standard dialysate through a series of bacteria- and endotoxin-retaining filters. Currently available systems for online hemodiafiltration are on the basis of conventional dialysis machines with added features to safely prepare and infuse replacement fluid and closely control fluid balance...
March 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29483138/mechanisms-clinical-implications-and-treatment-of-intradialytic-hypotension
#10
REVIEW
Patrick B Reeves, Finnian R Mc Causland
Individuals with ESKD requiring maintenance hemodialysis face a unique hemodynamic challenge, typically on a thrice-weekly basis. In an effort to achieve some degree of euvolemia, ultrafiltration goals often involve removal of the equivalent of an entire plasma volume. Maintenance of adequate end-organ perfusion in this setting is dependent on the institution of a variety of complex compensatory mechanisms. Unfortunately, secondary to a myriad of patient- and dialysis-related factors, this compensation often falls short and results in intradialytic hypotension...
February 26, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29482263/why-does-the-choice-of-dialysate-sodium-concentration-remain-controversial
#11
REVIEW
Kamonwan Tangvoraphonkchai, Andrew Davenport
The choice of the ideal dialysate sodium concentration remains controversial. Most dialysis centers have a standard dialysate concentration. In theory, choosing a dialysate sodium concentration lower than serum sodium should result in an additional loss of sodium by diffusion with a reduction in the prevalence of hypertension and interdialytic weight gains (IDWGs) on one hand, but with potential increased risk of intradialytic hypotension and cramps on the other hand, and the opposite effects may accompany the choice of dialysate sodium concentrations greater than serum concentration...
February 26, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29479995/effect-of-acute-intradialytic-aerobic-and-resistance-exercise-on-one-day-blood-pressure-in-patients-undergoing-hemodialysis-a-pilot-study
#12
Joon-Sik Kim, Joo-Hark Yi, Jinho Shin, Yeon-Soo Kim, Sang-Woong Han
BACKGROUND: Hypertension and intradialytic hypotension are independent risk factors for mortality in hemodialysis patients. We hypothesized that intradialytic exercise would increase blood pressure (BP) during dialysis and decrease it during the postdialytic period. The present study aimed to investigate the effect of acute intradialytic exercise on BP both during dialysis and for 20 hours post-dialysis, and to detect any differences in effects of aerobic exercise (AE), resistance exercise (RE), and usual care (UC-the control condition)...
February 26, 2018: Journal of Sports Medicine and Physical Fitness
https://www.readbyqxmd.com/read/29478062/novel-insights-into-the-pathogenesis-and-prevention-of-intradialytic-hypotension
#13
Frank M van der Sande, Marijke J Dekker, Karel M L Leunissen, Jeroen P Kooman
BACKGROUND: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. SUMMARY: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia...
2018: Blood Purification
https://www.readbyqxmd.com/read/29477417/intradialytic-hypotension-related-episodes-identification-based-on-the-most-effective-features-of-photoplethysmography-signal
#14
Vahid Reza Nafisi, Mina Shahabi
BACKGROUND AND OBJECTIVE: One of the most adverse conditions facing the hemodialysis patient is repetitive hypotension during their dialysis session. Different factors can be used to monitor patient conditions and prevent Intradialytic Hypotension (IDH) during hemodialysis. These factors include blood pressure, blood volume, and electrical Impedance factors. In this paper, pre-IDH and IDH episodes were recognized and classified by using the features of the finger photoplethysmography (PPG) signal...
April 2018: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/29470006/oxygen-saturation-and-heart-rate-variations-as-predictors-of-intradialytic-hypotension
#15
Vincent King Yu Chan, Lawrence Wing Chi Chan, Daniel Hung Kay Chow
AIntradialytic hypotension (IDH) occurring during hemodialysis (HD) may cause severe complications and can be life-threatening. IDH is a common symptom in patients with end stage renal disease undergoing HD. Currently, no effective predictive models for IDH exist. This study analyzed data on variations in oxygen saturation (SaO2 ) and heart rate (HR) in 68 patients during their HD sessions by using sequence alignment and Boolean algebra. Three classifiers derived from SaO2 and HR variation data were developed as predictors for predetermining IDH occurrence within 30 minutes...
January 2018: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
https://www.readbyqxmd.com/read/29461016/postdialysis-recovery-time-is-extended-in-patients-with-greater-self-reported-depression-screening-questionnaire-scores
#16
Andrew Davenport, Ayman Guirguis, Michael Almond, Clara Day, Joseph Chilcot, Maria Da Silva Gane, Naomi Fineberg, Karin Friedl, Benjamin Spencer, David Wellsted, Ken Farrington
INTRODUCTION: Most patients take time to recover after a hemodialysis (HD) session. It has been suggested that recovery time is associated with intradialytic hypotension and rapid solute clearances. Other studies have reported a linkage to depression. We investigated the association between recovery time and intradialytic hypotension and depression. METHODS: In five UK HD units, we screened for depressive symptoms using the Beck depression inventory-II, Patient Health Questionnaire, and recorded sessional blood pressures and Kt/Vurea...
February 20, 2018: Hemodialysis International
https://www.readbyqxmd.com/read/29455201/deterioration-of-hepatic-oxygenation-precedes-an-onset-of-intradialytic-hypotension-with-little-change-in-blood-volume-during-hemodialysis
#17
Sojiro Imai, Susumu Ookawara, Kiyonori Ito, Satoshi Kiryu, Kaoru Tabei, Yoshiyuki Morishita
No abstract text is available yet for this article.
2018: Blood Purification
https://www.readbyqxmd.com/read/29446172/measuring-the-prevalence-of-intradialytic-hypotension-in-a-satellite-dialysis-clinic-are-we-too-complacent
#18
Ulrich Steinwandel, Nick Gibson, Mandy Towell-Barnard, Richard Parsons, James Jr Rippey, Johan Rosman
AIMS AND OBJECTIVES: To measure the prevalence of symptomatic (S-IDH) and asymptomatic intradialytic hypotension (A-IDH) or postdialysis overhydration in a satellite haemodialysis clinic in Western Australia. BACKGROUND: Intradialytic hypotension is one of the most common side effects of haemodialysis caused by ultrafiltration provoking a temporary volume depletion. The prevalence of asymptomatic hypotension during dialysis has been rarely reported, but is considered to have the same negative consequences as symptomatic hypotension on various end organs like the brain and the gastrointestinal tract...
April 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29437702/diagnosis-and-treatment-of-intradialytic-hypotension-in-maintenance-hemodialysis-patients
#19
Christopher W McIntyre, Fabio R Salerno
No abstract text is available yet for this article.
March 7, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29436152/immersion-enhanced-fluid-redistribution-can-prevent-intradialytic-hypotension-a-prospective-randomized-crossover-clinical-trial
#20
Keren Doenyas-Barak, Nedal Garra, Ilia Beberashvili, Shai Efrati
INTRODUCTION: Intradialytic hypotension (IDH) is an important cause of morbidity and mortality among hemodialysis patients. We used an immersion model to evaluate the role of reduced effective circulating volume, and to examine whether facilitated refilling can prevent IDH. METHODS: Ten male hemodialysis patients who had frequent episodes of IDH were randomized to a mid-week "wet" or "dry" hemodialysis session, and subsequently underwent the other session in a crossover manner...
February 13, 2018: Hemodialysis International
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