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Intradialytic hypotension

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https://www.readbyqxmd.com/read/28730673/autonomic-dysfunction-as-a-mechanism-of-intradialytic-blood-pressure-instability
#1
Tariq Shafi, Surekha Mullangi, Bernard G Jaar, Harry Silber
The autonomic nervous system (ANS) is the principal endogenous defense mechanism that maintains blood pressure in the setting of hypotension. Disruption of the ANS impairs this ability and can contribute to blood pressure instability, including hypotension and hypertension. In this narrative review, we provide an overview of the ANS and the consequences of its dysfunction in patients with end-stage kidney disease treated with dialysis. We also discuss possible mechanisms of this autonomic dysfunction that may need future investigation...
July 20, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28728576/beneficial-effect-of-kidney-transplantation-from-a-deceased-donor-on-severe-chronic-refractory-intradialytic-hypotension-a-case-report
#2
Ewa Ignacak, Dominik Cieniawski, Alina Bętkowska-Prokop, Czesław Osuch, Marek Kuźniewski, Władysław Sułowicz
BACKGROUND: Chronic refractory hypotension (IDH, intradialytic hypotension) is a rare but serious problem encountered in patients on hemodialysis. Patients with chronic hypotension are often disqualified by transplant teams from renal transplantation. This is due to the possibility of an enormous risk of ischemic complications. CASE PRESENTATION: We describe a 44-year old female patient with severe refractory hypotension (mean BP 60/30 mmHg, the lowest 48/28 mmHg), which appeared after bilateral laparoscopic nephrectomy of the infected kidneys...
July 20, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28707330/the-impact-of-dialysis-modality-and-membrane-characteristics-on-intradialytic-hypotension
#3
Samir Patel, Jochen G Raimann, Peter Kotanko
The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published in English that investigated the association between IDH and dialysis modality and membrane, respectively. This literature search revealed 669 publications on dialysis modality, 64 on dialysis membrane, and 24 on acetate/bicarbonate dialysate...
July 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28707302/dialysate-sodium-and-intradialytic-hypotension
#4
Wael F Hussein, Brigitte Schiller
Intradialytic hypotension (IDH) is a common complication in hemodialysis, particularly with the time and frequency constraints of standard session delivery in contemporary practice. High intradialytic weight gain (IDWG), high ultrafiltration rates (UFR), and frequent IDH are highly interlinked, and separately or together contribute to the high cardiovascular morbidity and mortality observed in the hemodialysis population. Using a lower concentration of sodium in the dialysate (D-Na) reduces sodium delivery to the patient during dialysis, and several studies reported the beneficial effect in controlling IDWG, UFR, and hypertension...
July 13, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28691195/definitions-of-intradialytic-hypotension
#5
Magdalene M Assimon, Jennifer E Flythe
Intradialytic hypotension (IDH) is a common and often distressful complication of hemodialysis. However, despite its clinical significance, there is no consensus, evidence-based medical definition for the condition. Over the years, numerous definitions have been implemented in both the clinical and research settings. Definition inconsistencies have hindered data synthesis and the development of evidence-based guidelines for the prevention and treatment of IDH, as well as prevented accurate estimation of the population burden of IDH and patient risk assessment...
July 9, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28682031/-the-peritoneal-ultrafiltration-in-patients-with-cardio-renal-disease
#6
Roberto Corciulo, Simone Corciulo
In Italy, the congestive heart failure is the leading cause of hospitalization and despite advances in therapy, the long-term prognosis is poor. Congestive heart failure is associated with advanced varying degrees of chronic renal disease that identify the cardio-renal syndrome type 2. High-dose diuretic therapy often fail to solve the water overload that is frequently the cause of death. The resistance to diuretics aggravates the state of the patient's edema and consequently morbidity and mortality. In the acute stage, the extracorporeal ultrafiltration unable to repair over hydration but needs frequent access weekly or midweek at the dialysis center...
March 2017: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28681510/impact-of-drugs-on-intradialytic-hypotension-antihypertensives-and-vasoconstrictors
#7
Tara I Chang
Intradialytic hypotension (IDH) is a common complication of hemodialysis and is associated with numerous adverse outcomes including cardiovascular events, inadequate dialysis, loss of vascular access, and death. It is estimated that approximately 20%-30% of all dialysis sessions are affected by IDH. In seeking ways to reduce the occurrence of IDH, dialysis providers often turn to pharmacological approaches: withholding antihypertensive medications prior to hemodialysis or administering vasoconstrictor medications...
July 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666082/intradialytic-hypotension-in-acute-kidney-injury-requiring-renal-replacement-therapy
#8
Shilpa Sharma, Sushrut S Waikar
The treatment of severe acute kidney injury (AKI) with dialytic support for renal replacement therapy can be life sustaining and permit recovery from critical illness. Like any interventional therapy, however, renal replacement therapy with intermittent hemodialysis or continuous therapy can cause complications. Intradialytic hypotension is a common complication and can cause further ischemic injury to the recovering kidneys, thereby reducing the probability of renal recovery. The optimal dialytic technique-continuous or intermittent-has not been conclusively demonstrated in randomized controlled trials...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666075/the-effect-of-treatment-time-dialysis-frequency-and-ultrafiltration-rate-on-intradialytic-hypotension
#9
George R Aronoff
Dialysis treatment time, the frequency of dialysis treatments, and the rate of fluid ultrafiltration-each impacts the incidence of intradialytic hypotension. These factors influence blood pressure independently and together. The strongest evidence supports that rapid ultrafiltration increases the likelihood of intradialytic hypotension and that combined strategies leading to a reduction in ultrafiltration rate have the greatest impact on reducing intradialytic hypotension. A practical approach to avoiding the effects of ultrafiltration on systemic hemodynamics would be to set a maximum ultrafiltration rate needed to achieve the desired fluid removal and vary the duration of the treatment to achieve that target volume...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666073/to-cool-or-too-cool-is-reducing-dialysate-temperature-the-optimal-approach-to-preventing-intradialytic-hypotension
#10
John W Larkin, Marta M Reviriego-Mendoza, Len A Usvyat, Peter Kotanko, Franklin W Maddux
Abnormal decreases in blood pressure during hemodialysis are frequent in end stage renal disease (ESRD) patients treated with hemodialysis, and thought to be largely due to an inadequate cardiovascular response to the rapid blood volume decline. Intradialytic hypotension (IDH) and cardiac instability during dialysis can increase risks for negative health consequences and is possibly preventable though several types of interventions. One intervention that holds promise for prevention of IDH in hemodialysis patients is to reduce the temperature of the dialysate to or below the patient's core temperature...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666072/special-situations-intradialytic-hypertension-chronic-hypertension-and-intradialytic-hypotension
#11
Peter Noel Van Buren, Jula K Inrig
Hypertension is a comorbidity that is present in the majority of end-stage renal disease patients on maintenance hemodialysis. This population is particularly unique because of the dynamic nature of blood pressure (BP) during dialysis. Modest BP decreases are expected in most hemodialysis patients, but intradialytic hypotension and intradialytic hypertension are two special situations that deviate from this as either an exaggerated or paradoxical response to the dialysis procedure. Both of these phenomena are particularly important because they are associated with increased mortality risk compared to patients with modest decreases in BP during dialysis...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28666069/setting-the-dry-weight-and-its-cardiovascular-implications
#12
Arjun D Sinha, Rajiv Agarwal
Volume overload is common and associated with adverse outcomes in the hemodialysis population including systemic hypertension, pulmonary hypertension, left ventricular hypertrophy, and mortality. Since the beginning of the era of maintenance dialysis, prescribing and maintaining a dry weight remains the standard of care for managing volume overload on hemodialysis. Reducing dry weight even by relatively small amounts has been shown to improve blood pressure and has been associated with reductions in left ventricular hypertrophy...
June 30, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28661565/a-brief-review-of-intradialytic-hypotension-with-a-focus-on-survival
#13
Jason A Chou, Kamyar Kalantar-Zadeh, Anna T Mathew
Intradialytic hypotension (IDH), a common complication of ultrafiltration during hemodialysis therapy, is associated with high mortality and morbidity. IDH, defined as a nadir systolic blood pressure of less than 90 mm Hg on more than 30% of treatments, is a relevant definition and is correlated with mortality. Risk factors for IDH include patient demographics, anti-hypertensive medication use, larger interdialytic weight gain, and dialysis prescription features as dialysate sodium, high ultrafiltration rate, and dialysate temperature...
June 29, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28643378/effects-of-weight-based-ultrafiltration-rate-limits-on-intradialytic-hypotension-in-hemodialysis
#14
James L Pirkle, Mary E Comeau, Carl D Langefeld, Gregory B Russell, Somer S Balderston, Barry I Freedman, John M Burkart
INTRODUCTION: High ultrafiltration (UF) rates can result in intradialytic hypotension and are associated with increased mortality. The effects of a weight-based UF rate limit on intradialytic hypotension and the potential for unwanted fluid weight gain and hospitalizations for volume overload are unknown. METHODS: This retrospective cohort study examined 123 in-center hemodialysis patients at one facility who transitioned to 13 mL/kg/h maximum UF rates. Patients were studied for an 8 week UF rate limit exposure period and compared to the 8-week period immediately prior, during which the cohort served as its own historical control...
June 23, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28634773/development-and-validation-of-a-fall-risk-assessment-index-for-dialysis-patients
#15
Kenichi Kono, Yusuke Nishida, Hiroki Yabe, Yoshihumi Moriyama, Toshihiko Mori, Ryota Shiraki, Takashi Sato
BACKGROUND: Dialysis patients often have low physical performance due to uremic sarcopenia, protein energy wasting (PEW), and incidence intradialytic hypotension (IDH), which are indicated as risk factors for falling. The objective of this study was to develop a symptom-encompassing evaluation form to predict falls with high sensitivity for dialysis patients. METHODS: A total of 251 patients who had been receiving maintenance hemodialysis therapy three times a week were enrolled in the study...
June 20, 2017: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/28633456/feeding-during-dialysis-risks-and-uncertainties
#16
Rajiv Agarwal, Panagiotis Georgianos
Allowing dialysis patients to eat during the treatment is controversial. It is, therefore, no surprise that practices and policies with respect to intradialytic food consumption vary considerably from unit to unit and from country to country. Those who defend the position of feeding during dialysis reason that intradialytic meals offer a supervised and effective therapy for protein-energy wasting. Those who take the opposite view argue that intradialytic food intake should be avoided for the following three reasons...
June 19, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28619098/interventions-to-prevent-hemodynamic-instability-during-renal-replacement-therapy-for-acute-kidney-injury-a-systematic-review-protocol
#17
Adrianna Douvris, Swapnil Hiremath, Lauralyn McIntyre, Lindsey Sikora, Catherine Weber, Edward G Clark
BACKGROUND: Hemodynamic instability during renal replacement therapy (HIRRT) in the form of intradialytic hypotension (IDH) is a frequent complication of hemodialysis in end-stage kidney disease (ESKD), and most studies have focused on this chronic population. However, HIRRT is also an important concern for critically ill ICU patients with acute kidney injury (AKI), complicating an estimated 30% of dialysis treatments in this population. HIRRT can exacerbate organ hypoperfusion in the setting of critical illness and may negatively impact renal recovery in the AKI population...
June 15, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28581677/interplay-of-volume-blood-pressure-organ-ischemia-residual-renal-function-and-diet-certainties-and-uncertainties-with-dialytic-management
#18
REVIEW
Ercan Ok, Nathan W Levin, Gulay Asci, Charles Chazot, Huseyin Toz, Mehmet Ozkahya
Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume...
June 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28554180/higher-ultrafiltration-rate-is-associated-with-longer-dialysis-recovery-time-in-patients-undergoing-conventional-hemodialysis
#19
Wael F Hussein, Rohini Arramreddy, Sumi J Sun, Marc Reiterman, Brigitte Schiller
BACKGROUND: Increased mortality and morbidity are reported in association with high ultrafiltration rate (UFR) and with long dialysis recovery time (DRT). We studied the association between UFR and DRT. METHODS: This is a cross-sectional, observational study was conducted. Patients on thrice-weekly hemodialysis (HD) with self-reported DRT between August and December 2014 were included. We examined the association of 30-day average UFR with recovery time. RESULTS: The total number of patients included in this study was 2,689...
2017: American Journal of Nephrology
https://www.readbyqxmd.com/read/28540893/comparison-of-intradialytic-hemodynamic-tolerance-between-on-line-hemodiafiltration-and-acetate-free-biofiltration-with-profiled-potassium-dialysate-concentration
#20
George Kosmadakis, Enrique Da Costa Correia, Frederic Somda, Didier Aguilera
Intradialytic hypotensive episodes are deleterious for hemodialysis (HD) patients. Acetate-free biofiltration with profiled potassium (AFBK) dialysate concentration may improve their cardiovascular stability. The aim of the present crossover study was to compare intradialytic hemodynamic tolerance and biological parameters between online hemodiafiltration (olHDF) and AFBK. Ten frail HD patients (8 males) with a mean age of 66.71- ± 12.31 years were studied for three months on olHDF and AFBK. There was a significant reduction of the hypotensive episodes during the AFBK period compared to the olHDF period...
May 2017: Saudi Journal of Kidney Diseases and Transplantation
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