Abstract
Introduction Approximately 15 to 33% of all dialysis treatments are complicated by intradialytic hypotension (IDH). In this study, we tested the hypothesis that the intravenous administration of hydrocortisone prior to HD treatment could prevent IDH or at least decrease the drop in the blood pressure resulting from IDH. Methods This study was approved by our local ethics committee/IRB (2017/87) and by the Jordan Food and Drug Administration (7/clinical/18). Additionally, it is registered on ClinicalTrials.gov (NCT03465007). In this preliminary investigational study, we screened all chronic hemodialysis patients at our clinic who were 18 years of age or older (n = 82) for IDH. There were 14 patients included in the interventional part of this study; patients were given IV hydrocortisone for 3 consecutive HD sessions, followed or preceded by 3 intervention-free sessions where they were given 5 ml of saline as a placebo. Results The initial total sample size was 82 patients. The frequency of IDH at our clinic was 24.4%. Fourteen out of the 20 patients who were diagnosed with IDH agreed to enroll in the interventional part of our study. The mean age of the patients in the interventional part of our study was 53.5 years (±10.3). These patients included 5 (35.7%) men and 9 (64.3%) women. Upon comparing the number of hypotensive attacks with and without the hydrocortisone administration, we found a significant difference (p = 0.003) between the hydrocortisone and placebo treatments in which 12 (85.7%) patients had fewer IDH episodes with the hydrocortisone treatment than with placebo. Conclusion This preliminary investigational study found that the administration of a stress dose of hydrocortisone prior to hemodialysis could be an effective measure for preventing or minimizing the risk of IDH episodes. Additional prospective studies on this subject are needed. Ruling out adrenal insufficiency in patients diagnosed with IDH is also crucial.
Highlights
15 to 33% of all dialysis treatments are complicated by intradialytic hypotension (IDH), which is associated with possible serious consequences [1,2,3,4]
The Kidney Disease Outcomes Quality Initiative (KDOQI) and European Best Practice Guidelines (EBPG) define intradialytic hypotension as a decrease in systolic blood pressure by ≥20 mmHg or a decrease in mean arterial pressure by 10 mmHg, and this is associated with clinical events and the need for nursing interventions [5]
In this study, we tested the hypothesis that the intravenous administration of 100 mg of hydrocortisone given 30 minutes prior to HD treatment could prevent IDH or at least decrease the drop in the blood pressure during HD treatment
Summary
15 to 33% of all dialysis treatments are complicated by intradialytic hypotension (IDH), which is associated with possible serious consequences [1,2,3,4]. The Kidney Disease Outcomes Quality Initiative (KDOQI) and European Best Practice Guidelines (EBPG) define intradialytic hypotension as a decrease in systolic blood pressure by ≥20 mmHg or a decrease in mean arterial pressure by 10 mmHg, and this is associated with clinical events and the need for nursing interventions [5]. We believe that hemodialysis patients will not have enough time to physiologically raise their cortisol level to cover the stress imposed by the HD treatment, and this could be one of the main contributing factors to the development of IDH. In this study, we tested the hypothesis that the intravenous administration of 100 mg of hydrocortisone given 30 minutes prior to HD treatment could prevent IDH or at least decrease the drop in the blood pressure during HD treatment
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