Improvement of Intradialytic Hypotension in Diabetic Hemodialysis Patients Using Vitamin E‐Bonded Polysulfone Membrane Dialyzers

Masahide Koremoto,Masahiro Takahashi,Junzou Kamei,Kouhei Satoh,Daisuke Nagasaku,Tetsurou Arimura,Itaru Ebihara,Takuji Kouzuma,Yasuhiro Okada,Noriko Takahara,Tomoyoshi Kimura,Tomoyuki Hirai,Shigeo Miyata,Shunji Maniwa

doi:10.1111/j.1525-1594.2012.01483.x

Abstract

Currently, there are no detailed reports on the effects of vitamin E-bonded polysulfone (PS) membrane dialyzers on intradialytic hypotension (IDH) in diabetic hemodialysis (HD) patients. This study was designed to evaluate changes in intradialytic systolic blood pressure (SBP) using “VPS-HA” vitamin E-bonded super high-flux PS membrane dialyzers. The subjects were 62 diabetic HD patients whose intradialytic SBP fell by more than 20%. Group A comprised patients who required vasopressors to be able to continue treatment or who had to discontinue therapy due to their lowest intradialytic SBP being observed at 210 min (28 patients). Group B comprised patients who showed no symptoms and required no vasopressors but showed a gradual reduction in blood pressure, with the lowest intradialytic SBP seen at the end of dialysis (34 patients). The primary outcome was defined as the lowest intradialytic SBP after 3 months using VPS-HA. Secondary outcomes included changes in the following: lowest intradialytic diastolic blood pressure, pulse pressure, pulse rate, plasma nitric oxide and peroxynitrite, serum albumin, and hemoglobin A1c. Group A's lowest intradialytic SBP had significantly improved at 3 months (128.0 ± 25.1 mm Hg vs. 117.1 ± 29.2 mm Hg; P = 0.017). Group B's lowest intradialytic SBP had significantly improved at 1 month (134.4 ± 13.2 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.047) and 3 months (139.1 ± 20.9 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.011). We conclude that VPS-HA may improve IDH in diabetic HD patients.

Highlights

We hypothesized that VPS-HA vitamin E-bonded super high-flux PS membrane dialyzer (Asahi Kasei Kuraray Medical), which has a higher permeability than VPS-H, might improve intradialytic hypotension (IDH) in diabetic nephropathy (DN) HD patients
In carrying out our study on DN HD patients who have IDH with comorbid symptoms, we focused on the treatment approach
We identified a different pattern of reduction in blood pressure between Group A and Group B (Table 2): intradialytic systolic blood pressure (SBP) and pulse pressure (PP) from 60 to 240 min in Group A were significantly lower than those in Group B, and intradialytic diastolic blood pressure (DBP) and Mean BP (MBP) at 300 min in Group A were significantly higher than those in Group B

Summary

Introduction

Matsumura et al reported that VPS-H vitamin E-bonded high-flux polysulfone (PS) membrane dialyzer (Asahi Kasei Kuraray Medical, Tokyo, Japan) improved the IDH of eight HD patients at a single center [8]. We hypothesized that VPS-HA vitamin E-bonded super high-flux PS membrane dialyzer (Asahi Kasei Kuraray Medical), which has a higher permeability than VPS-H, might improve IDH in DN HD patients. All participants had shown decreased SBP under HD by more than 20% when using conventional dialyzers in the 3 months preceding enrollment Subjects who had cardiovascular disease with Class III and IV symptoms, as defined by the New York Heart Association criteria, were excluded All patients submitted their written informed consent before the start of the study

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