Abstract
Orthostatic hypotension is a risk factor for falls among chronic hemodialysis (HD) patients. This study aimed to investigate the hemodynamic response to orthostatic stress immediately after an HD session. Twenty-one HD patients (mean age, 70.2 ± 8.1 years; HD duration, 7.5 ± 6.4 years) participated in this study. Each 5-min hemodynamic monitoring was performed in the supine, semi-recumbent, and sitting positions immediately after an HD session. Hemodynamic variables were measured using a noninvasive beat-to-beat monitoring device during the test. Patients were divided into an intradialytic hypotension (IDH) group and a non-IDH group according to the presence or absence of IDH on the day of the measurements, and intra- and intergroup comparisons were performed. In the IDH group, the nadir values of systolic blood pressure in the semi-recumbent and sitting positions were significantly lower than those in the supine position and the last systolic blood pressure in the semi-recumbent position. The nadir of stroke volume in the sitting position was significantly lower than that in the supine position. There were no statistically significant intergroup differences in the changes for any positions. These results suggest that patients with IDH require special attention when getting out of bed to prevent post-dialytic falls.
Highlights
Orthostatic hypotension (OH) is caused by an excessive decrease in cardiac output (CO) and/or compensatory vasoconstrictor mechanisms such as autonomic failure and age-related physiologic changes [1]
Demographic and clinical characteristics The demographic and clinical characteristics obtained from patients’ medical records included age, sex, body mass index, presence of underlying diabetes mellitus (DM), HD vintage, dry weight, cardiothoracic ratio, left ventricular ejection fraction (LVEF) by echocardiography, and hemoglobin (Hb), hematocrit (Ht), blood urea nitrogen, creatinine, albumin (Alb), total cholesterol, triglyceride, high-density lipoprotein cholesterol, and C-reactive protein levels in a blood sample obtained before HD
Clinical and demographic characteristics We evaluated 21 patients; three patients were excluded before the hemodynamic monitoring because of discomfort including nausea just after the HD session
Summary
Orthostatic hypotension (OH) is caused by an excessive decrease in cardiac output (CO) and/or compensatory vasoconstrictor mechanisms such as autonomic failure and age-related physiologic changes [1]. OH is a risk factor for falls among chronic hemodialysis (HD) patients. The cross-sectional prevalence of OH in HD patients is reportedly higher than that in the general population. Previous studies reported a 42% prevalence of OH in the introductory phase of HD [2] versus 5–30% in unselected individuals aged ≥ 65 years [3]. In the post-dialysis period, there are several HD-related risk factors for OH such as the rapid removal of intravascular volume and several hours of bed rest during HD therapy, in addition to other common risk factors such as advanced age, autonomic failure, and frailty.
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