VOLUME REPLENISHMENT BY BOLUS LIQUID INFUSION: WHATROLE IN THE ACUTE MANAGEMENT OF INTRADIALYTIC HYPOTENSION (IDH)?

Abstract

Introduction: Intradialytic hypotension (IDH) is a common complication associatedwith high morbidity and mortality in hemodialysis patients. Its management isprimarilypreventive, but if itoccurs, itrequires urgent measuresincluding volume infusion of solute to restore volemia. The objective of ourworkis to evaluate the role of bolus liquid infusion for the acute management of IDH. Materials and Methods: This is a retrospectivestudyconductedfromJanuary 2017 to December 2021 at the hemodialysis center of the militaryhospital in Agadir involving 90 chronichemodialysis patients. Volume replenishment to treat IDH wascarried out by infusing an online bolus liquid. Results and Discussion: Weanalyzed 30,689 sessions. IDH with or withoutsymptomswasfoundin 19.6% of cases. 14% of sessions with IDH required bolus infusion (27% of total sessions) with an average volume injected of 26315 ± 1622 ml. Factorsassociatedwith bolus administration includedadvancedage (643 ± 127 vs. 61.6 ± 12.7 years, P<0.001), femalesex (H/F ratio of 0.5 vs. 1.1, P<0.001), diabetes (47.4% vs. 44%, P<0.001), lowpre-dialyticnatremia (134 ± 14 vs. 136 ± 10 mmol/l, P<0.001), and underestimated dry weight (70.6 ± 12.5 vs. 73 ± 14.2 kg, P<0.001). Sessions with bolus infusion werecharacterized by a low total effective UF volume (2000 ± 870 ml vs. 2285.8 ± 854.8, P<0.001), shorter duration withpremature session disconnection (209 ± 25 min vs. 235 ± 7 min, P=0.02), and loweraveragedialysatetemperature (P<0.001). The final relative blood volume washigher (87 ± 9 vs. 82 ± 9, P<0.001) favoring the risk of overloadassociatedwith bolus infusion. Conclusion: Despiteadvances in hemodialysis, IDH remains a common per-dialytic incident. Our study highlights the importance of close monitoring of hemodynamicparametersduringhemodialysis sessions to prevent IDH, actearly, and avoidliquid bolus administration associatedwith the risk of overload.