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Intradialysis hypotension

Enajite I Okaka, Chimezie G Okwuonu
BACKGROUND: Blood pressure (BP) variation is commonly encountered during hemodialysis (HD) procedure. Both intradialysis hypotension and hypertension have implications for outcome of treatment and overall morbidity and mortality of the patients. METHODOLOGY: A retrospective study was carried out in the dialysis unit of a tertiary health institution in Benin City among patients who had HD for acute kidney injury (AKI) or chronic kidney disease (CKD) over a 3-year period...
April 2017: Annals of African Medicine
Beata Franczyk, Anna Gluba-Brzózka, Piotr Bartnicki, Jacek Rysz
PURPOSE: Atrial fibrillation is a serious problem, especially in patients on dialysis. The prevalence of AF in this group of patients is higher than in general population and associated with increased mortality. The aim of this study was to assess the risk of the occurrence of atrial fibrillation related to intradialysis hypotension and left atrium volume enlargement associated with dialysis. The influence of dialysis session on: E/E', V LA, E/A, E', V RA and the width of inferior vena cava of RV was analyzed...
June 2017: International Urology and Nephrology
Effat Razeghi, Simin Dashti-Khavidaki, Samira Nassiri, Rozita Abolghassemi, Hossein Khalili, Seyed Saeed Hashemi Nazari, Mohammad Ali Mansournia, Mohammad Taraz
INTRODUCTION: Intradialytic hypotension (IDH) has been reported in 15% to 50% of hemodialysis patients and increases patients morbidity and mortality. Some small noncontrolled studies evaluated the effect of sertraline on IDH with conflicting results. This study is a randomized crossover controlled trial on the effectiveness of sertraline to reduce IDH. MATERIALS AND METHODS: Patients on hemodialysis who suffered IDH in at least 50% of their dialysis sessions were enrolled...
July 2015: Iranian Journal of Kidney Diseases
Bianca Ballarin Albino, André Luis Balbi, Juliana Maria Gera Abrão, Daniela Ponce
Prolonged intermittent renal replacement therapy (PIRRT) has emerged as an alternative to continuous renal replacement therapy in the management of acute kidney injury (AKI) patients. This trial aimed to compare the dialysis complications occurring during different durations of PIRRT sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline doses ranging from 0.3 to 0.7 µg/kg/min. Patients were divided into two groups randomly: in G1, 6-h sessions were performed, and in G2, 10-h sessions were performed...
May 2015: Artificial Organs
Bianca Ballarin Albino, André Luis Balbi, Daniela Ponce
This trial aimed to compare the dialysis complications occurring during different durations of extended daily dialysis (EDD) sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline dose ranging from 0.3 to 0.7 μg/kg/min. Patients were divided into two groups randomly: in G1, 6 h sessions were performed and, in G2, 10 h sessions were performed. Seventy-five patients were treated with 195 EDD sessions for 18 consecutive months...
2014: BioMed Research International
Chiz-Tzung Chang, Ming-Hui Chien, Kai-Liang Yang, Chien-Chih Yu, Jing-Fang Hsu, I-Kuan Wang, Paik-Seong Lim, Chiu-Ching Huang
AIM: A decrease of systolic blood pressure in excess of 20 mmHg during haemodialysis treatment (IDD) is common for haemodialysis patients. Intradialytic hypotension (IDH) is symptomatic IDD by definition. Overproduction of nitric oxide (NO) is a possible cause of IDD. Dialysate nitrate and nitrite amount can be used as an indicator of intradialysis NO production. Our aim was to find the predictor of NO production in IDD patients. METHODS: Partial dialysate samples were collected during the whole haemodialysis session and total dialysate nitrate and nitrite amount was measured to assess the association of intradialysis NO production with blood pressure change...
September 2014: Nephrology
A Chijioke, A M Makusidi, M O Rafiu
The epidemiology of acute renal failure (ARF) varies between nations and even within the same country because of differences in diagnostic criteria, causes, mode of presentation, and cost of therapy. To determine the factors influencing hemodialysis and outcome of severe ARF in Ilorin, Nigeria, we studied ARF patients on hemodialysis in our center between January 1989 and December 2009. There were 138 (58 males and 80 females) patients with age range between 18 and 69 years and a mean of 29.4 ± 11.9 years...
March 2012: Saudi Journal of Kidney Diseases and Transplantation
Antonio Santoro
There is no doubt that arterial hypertension in dialysis patients as well as in patients without renal disease is deleterious for the cardiovascular system. Reducing the pressure values to 130/80 mmHg is what the guidelines suggest. The dialysis setting, however, presents a very different scenario from that of the general population. Dialysis per se is the most powerful of the pharmacological measures in blood pressure control. At the same time, dialysis is an interfering factor in pressure control and can even foster the onset of a perverse vicious circle with, in the same patient, the onset of severe intradialysis hypotension and hypertensive crises in the interdialysis period...
May 2011: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Aicha Merouani, Wassim Kechaou, Catherine Litalien, Thierry Ducruet, Philippe Jouvet
BACKGROUND: In chronic pediatric patients treated with intermittent hemodialysis (IHD), blood volume monitoring (BVM) is commonly used to assess and manage volume status during the dialysis session. Minimal data exists on its use during IHD in critically ill children with acute kidney injury (AKI). In these cases, fluid removal may be limited by hemodynamic instability. METHODS: We present a retrospective study conducted in our pediatric intensive care unit. For eligible patients, demographic data and IHD treatment characteristics were recorded including BVM use, ultrafiltration (UF) volume per session, hypotensive episodes and intradialysis interventions...
October 2011: Nephrology, Dialysis, Transplantation
J Matthew Brennan, Adam Ronan, Sascha Goonewardena, John E A Blair, Mary Hammes, Dipak Shah, Samip Vasaiwala, James N Kirkpatrick, Kirk T Spencer
Accurate intravascular volume assessment is critical in the treatment of patients who receive chronic hemodialysis (HD) therapy. Clinically assessed dry weight is a poor surrogate of intravascular volume; however, ultrasound assessment of the inferior vena cava (IVC) is an effective tool for volume management. This study sought to determine the feasibility of using operators with limited ultrasound experience to assess IVC dimensions using hand-carried ultrasounds (HCU) in the outpatient clinical setting. The IVC was assessed in 89 consecutive patients at two outpatient clinics before and after HD...
July 2006: Clinical Journal of the American Society of Nephrology: CJASN
Tatsuya Shoji, Yoshiharu Tsubakihara, Masamitsu Fujii, Enyu Imai
BACKGROUND: The relationship between blood pressure (BP) and mortality in hemodialysis patients has remained controversial. Some studies suggested that a lower pre- or postdialysis BP was associated with excess mortality, while others showed poorer outcome in patients with uncontrolled hypertension. We conducted a multicenter prospective cohort study to evaluate the impact of hemodialysis-associated hypotension on mortality. METHODS: We recruited 1244 patients (685 males; mean age, 60 +/- 13 years) who underwent hemodialysis in 28 units during the two-year study period beginning in December 1999...
September 2004: Kidney International
L Iu Milovanova, A Iu Nikolaev, V V Safonov, Iu S Milovanov
AIM: To study causes and sequelae of intradialysis hypotension (IH) in patients with terminal renal failure (TRF). MATERIAL AND METHODS: Forty one patients with TRF on chronic hemodialysis (CH) were divided into two groups. The study group consisted of 24 patients with episodes of IH. Seventeen patients of the control group had no IH. All the patients were examined with assessment of protein-energy deficiency, residual renal function, left-ventricular hypertrophy, diastolic function of the heart...
2003: Terapevticheskiĭ Arkhiv
Po-Tsang Lee, Hua-Chang Fang, Chien-Liang Chen, Hsiao-Min Chung, Yee-Hsuan Chiou, Kang-Ju Chou
BACKGROUND: Intradialysis hypotension is a common problem among hemodialysis patients. Some studies have shown that autonomic neuropathy could be a major cause of intradialysis hypotension, whereas others have not. Furthermore, whether there are parallel changes in the autonomic nervous system and somatic nerves remains unclear. METHODS: We investigated the autonomic and peripheral nervous functions of 12 chronic hemodialysis patients who suffered from intradialysis hypotension, and of 12 age- and sex-matched hemodialysis patients who had stable blood pressure during hemodialysis...
September 2003: Kidney International
Feng Ding, Peter Ahrenholz, Roland E Winkler, Wolfgang Ramlow, Michael Tiess, Ann Michelsen, Wolfgang Pätow
Online hemodiafiltration (online HDF) and acetate-free biofiltration (AFB) are 2 innovative renal replacement therapies. Convincing evidence has shown that both techniques are superior to conventional hemodialysis in many aspects. The aim of the present investigation was to compare online HDF and AFB in 12 stable maintenance hemodialysis patients in a prospective, randomized crossover trial. Twelve stable dialysis patients, age 49.7 +/- 11.3 years and on dialysis for 83.5 +/- 76.7 months, were treated prospectively and randomly by either AFB, predilution HDF (pre-HDF), or postdilution HDF (post-HDF) for a total of 36 weeks using exclusively F60S high-flux dialyzers...
February 2002: Artificial Organs
D O McGregor, A L Buttimore, K L Lynn, M G Nicholls, D L Jardine
We conducted a randomized crossover trial to establish, within patients, whether long-slow hemodialysis (HD) was associated with better blood pressure (BP) control than standard HD. Nine home HD patients, not on antihypertensive drugs, were dialyzed to the same eKt/V(urea) and target weights for 6-8 h (LD) at home and for 3.5-4.5 h (SD) in the dialysis center 3 times weekly in randomized sequence, with each phase lasting 8 weeks. Ambulatory BP, bioimpedance, neurohormones and autonomic function were measured in each phase...
2001: Blood Purification
U Anand, B Bastani, P Dhanraj, S H Ballal
Intradialysis hypotension is a common problem, especially in patients with poor left-ventricular function. We studied 6 patients who were on maintenance hemodialysis with left-ventricular ejection fraction of <40%, whose dialysis sessions were often complicated with severe hypotension (systolic blood pressure <90 mm Hg). Dobutamine infusion during dialysis significantly reduced the number of hypotensive episodes, increased left-ventricular ejection fraction, and decreased the number of emergency admissions to the hospital...
1999: American Journal of Nephrology
F Locatelli, C Manzoni, S Di Filippo, S Andrulli
BACKGROUND: Despite technological advances in dialysis equipment, the morbidity and quality of life of uraemic patients undergoing regular haemodialytic treatment are still severely affected by acute intradialytic complications possibly related to the treatment itself. Cardiovascular instability still affects >30% of dialytic sessions and, although its pathogenesis is multifactorial, dialysate sodium concentration (and, consequently, intradialytic sodium removal) is one of the main factors affecting intradialytic hypotension...
1999: Nephrology, Dialysis, Transplantation
Q Maggiore, P Dattolo, M Piacenti, M A Morales, G Pelosi, F Pizzarelli, T Cerrai
Many studies have confirmed our original observation that dialysate T set at about 35 degrees C affords a better hemodynamic protection than the standard dialysate T of 37-38 degrees C. In this review we present some new data on the hemodynamic mechanism of the protective effect of cold dialysis on blood pressure. The study was based on serial assessment of the percent changes occurring during dialysis treatment in estimated stroke volume (aortic blood flow determined by Doppler echocardiography), blood volume (hemoglobinometry), arterial pressure (Dynamap), and heart rate (ECG), from which cardiac output (CO) indexes and total peripheral vascular resistances (TPVR) were derived...
September 1995: International Journal of Artificial Organs
F Pizzarelli, P Dattolo, M Piacenti, M A Morales, T Cerrai, Q Maggiore
We studied in 13 hemodialysis patients intradialytic variations of blood volume (BV) and cardiac output, by means of non-invasive methods. We found a weak correlation, r 0.2 or less, between BV variations and intradialysis blood pressure variations. The sensitivity of the former in describing the variations of the latter was only 32%. During the 30 min preceeding the hypothensive crisis the percent BV variations did not show any predictive trend. On the contrary, refilling increased as blood pressure dropped and a weak inverse relation (r -0...
September 1995: International Journal of Artificial Organs
C Bazzi, G Arrigo, L Luciani, F Casazza, M Saviotti, D Malaspina, E Bonucci, P Ballanti, S Amaducci, P Lattuada
Careful investigation of the clinical conditions of patients on maintenance hemodialysis for about 20 years in a single dialysis unit was of great interest for evaluation of the pathological consequences in long-term survivors of insufficient correction of uremia and of the dialysis treatment "per se". We analyzed the outcomes for a cohort of 116 patients who started RDT before 1976 and the clinical conditions of the 24 patients still on RDT in our unit at the end of 1991 (average duration of treatment = 222 +/- 23 months)...
August 1995: Clinical Nephrology
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