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Intradialytic hypotension

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
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
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
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
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...
January 26, 2018: Blood Purification
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
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
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
Sojiro Imai, Susumu Ookawara, Kiyonori Ito, Satoshi Kiryu, Kaoru Tabei, Yoshiyuki Morishita
No abstract text is available yet for this article.
February 16, 2018: Blood Purification
Ulrich Steinwandel, Nick Gibson, Mandy Towell, Richard Parsons, James Rippey, Johan Rosman
AIMS AND OBJECTIVES: Measuring the prevalence of symptomatic (S-IDH) and asymptomatic intradialytic hypotension (A-IDH) or post-dialysis 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 gastro-intestinal tract...
February 15, 2018: Journal of Clinical Nursing
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
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
Jinbo Yu, Zhonghua Liu, Bo Shen, Jie Teng, Jianzhou Zou, Xiaoqiang Ding
AIMS: This study aimed to assess risk factors of intradialytic hypotension (IDH) and the association of prognosis and IDH among maintenance hemodialysis (MHD) patients. METHODS: Among 293 patients, 117 were identified with IDH (more than 4 hypotensive events during 3 months). The association between IDH and survival was evaluated. RESULTS: The incidence of IDH was 39.9%. Age, ultrafiltration rate, N-terminal pro-B-type natriuretic peptide (NT-proBNP), albumin, β2-microglobulin (β2MG), and aortic root inside diameter (AoRD) were independently associated with IDH...
February 2, 2018: Blood Purification
Minmin Sun, Xuesen Cao, Yao Guo, Xiao Tan, Lili Dong, Cuizhen Pan, Xianhong Shu
BACKGROUND: Right ventricular (RV) dysfunction is a major cause of death in patients undergoing maintenance hemodialysis (MHD). We used 3-dimensional speckle-tracking echocardiography (3DSTE) to evaluate long-term impacts of MHD on RV function. HYPOTHESIS: In this study, RV dysfunction in MHD patients will be revealed and studied in depth by 3DSTE. METHODS: Echocardiography was performed on 110 consecutively enrolled individuals: 30 controls and 80 patients with MHD...
January 24, 2018: Clinical Cardiology
Kada Klouche, Laurent Amigues, Marion Morena, Vincent Brunot, Anne Marie Dupuy, Audrey Jaussent, Marie Christine Picot, Noémie Besnard, Delphine Daubin, Jean Paul Cristol
BACKGROUND: Though on-line intermittent hemodiafiltration (OL-IHDF) is a routine therapy for chronic dialysis patients, it is not yet widespread used in critically ill patients. This study was undergone to evaluate efficiency and tolerance of OL-IHDF and to appreciate inflammatory consequences of its use in intensive care unit (ICU)-acute kidney injury (AKI) patients. METHODS: In this prospective cohort study conducted in a medical academic ICU in France, 30 AKI patients who underwent OL-IHDF were included...
December 22, 2017: BMC Nephrology
Luiz Paulo José Marques, Paulo Roberto Silva Marinho, Regina Rocco, Caroline de Azevedo Martins, Henrique Novo Costa Pereira, Ana Clara Lopes Barbosa Ferreira
INTRODUCTION: Patient who was undergoing hemodialysis (HD) thrice weekly usually gain 1 to 4 kg of weight in interdialytic period, mainly due to fluid accumulation by ingestion of water. Ultrafiltration (UF) during HD will be need to remove fluid excess to avoid severe medical complications secondary to fluid overload. However, in pregnant woman UF can increase the episodes of intradialytic hypotension which may lead to placental ischemic injury and predispose to fetal distress. There is little information about safe fluid amount withdrawn by UF during pregnancy...
December 11, 2017: Hemodialysis International
Gabriele Donati, Mauro Ursino, Alessandra Spazzoli, Nicolò Natali, Roberto Schillaci, Diletta Conte, Andrea Angeletti, Anna Laura Croci Chiocchini, Irene Capelli, Olga Baraldi, Gaetano La Manna
BACKGROUND: Sodium prescription in patients with intradialytic hypotension remains a challenge for the attending nephrologist, as it increases dialysate conductivity in hypotension-prone patients, thereby adding to dietary sodium levels. METHODS: New sodium prescription strategies are now available, including the use of a mathematical model to compute the sodium mass to be removed during dialysis as a physiological controller. RESULTS: This review describes the sodium load of patients with end-stage renal disease on chronic hemodialysis (HD) and discusses 2 strategies to remove excess sodium in patients prone to intradialytic hypotension, namely, Profiled HD and the hemodiafiltration Aequilibrium System...
November 23, 2017: Blood Purification
Wendi Bradshaw, Paul N Bennett, Cherene Ockerby, Alison M Hutchinson, Peter G Kerr
Intradialytic hypotension (IDH) remains the most frequent severe side effect of hemodialysis. This prospective, exploratory study aimed to measure the compliance of an IDH prevention pathway and to identify the effects of pathway use on hypotension incidence. Additionally, the study explored barriers and facilitators to pathway implementation in five hemodialysis centers. Instituting an ultrafiltration pause decreased the odds of hypotensive episodes by 44% (OR = 0.56, 95% CI = 0.20 to 1.56, χ2 1 = 1.25, p = 0...
March 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
George Kosmadakis, Enrique Da Costa Correia, Julie Albaret, Frédéric Somda, Didier Aguilera
PURPOSE: Acetate in hemodialysis solutions exerts inflammatory, vasodilatatory and cardio-depressive effects. Citrate has been proposed as an optimal substitute. The aim of the present trial was the comparison of the hemodynamic and biological parameters on a group of patients dialysed consecutively with 4 acetate-free haemodialysis techniques. METHODS: In a prospective crossover manner, we measured the hemodynamic and biological effects of four acetate-free hemodialysis methods: he acetate-free biofiltration with variable potassium (AFBK) and three methods with a citrate buffer: onventional hemodialysis (HD), on-line hemodiafiltration (HDF) and on-line hemofiltration (HF)...
December 2017: Néphrologie & Thérapeutique
Sardar Ansari, Somayeh Molaei, Kenn Oldham, Michael Heung, Kevin R Ward, Kayvan Najarian
Intradialytic hypotension (IDH) is the most common complication of hemodialysis, affecting 15-50% of all dialysis sessions. Previously, we had presented a non-invasive Polyvinylidene Fluoride (PVDF) based sensor in the form of a ring to measure vascular tone and we showed that the morphology of the signal can be utilized to predict IDH. This paper presents an approach for analyzing the PVDF signal using extended Kalman filter (EKF) and a synthetic model that has previously been used to model the ECG signal with Gaussian functions...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
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