Hypotension-prone Hemodialysis Research Articles

Comparison of the hemodynamic tolerance and the biological parameters of four acetate-free hemodialysis methods

PurposeAcetate in hemodialysis solutions exerts inflammatory, vasodilatatory and cardio-depressive effects. Citrate has been proposed as an optimal substitute. The aim of the present trial was the comparison of the hemodynamic and biological parameters on a group of patients dialysed consecutively with 4 acetate-free haemodialysis techniques. MethodsIn a prospective crossover manner, we measured the hemodynamic and biological effects of four acetate-free hemodialysis methods: he acetate-free biofiltration with variable potassium (AFBK) and three methods with a citrate buffer: onventional hemodialysis (HD), on-line hemodiafiltration (HDF) and on-line hemofiltration (HF). Fourteen chronic hemodialysis patients (9 males mean age 72.21±11.21 years old) underwent 6 four-hour dialysis sessions for 2 weeks on each of the 4 studied techniques. ResultsThe AFBK technique presented less intradialytic hypotensive episodes (1 in 84 sessions) compared to the other techniques (HD: 29/84, HDF 22/82 and HF: 14/78; P<0.001). The blood pressure after one, two, three hours of dialysis and at the end of the hemodialysis session was significantly higher in the AFBK technique. On AFBK the net ultrafiltration (UF) (P<0.001) and the UF as a percentage of the dry weight (P=0.005) were significantly higher. A significant correlation between the prevalence of hypotensive episodes and the change of serum potassium levels (P=0.002) during the first hour of dialysis was detected. ConclusionsAFBK is associated with a better intradialytic hemodynamic tolerance and could be an optimal method for frail hypotension-prone hemodialysis patients.

The dialysis staff workload and the blood volume tracking system during the hemodialysis sessions of hypotension-prone patients.

Intradialytic hypotension (IDH) represents a common hemodialysis (HD) complication. Blood volume tracking (BVT) is a tool regulating the relative blood volume changes and potentially reducing the occurrence of IDH. The aim of this study was to evaluate the ability of BVT to reduce the staff workload associated to IDH. Ten hypotension-prone HD patients were treated each with 39 conventional HD (HD) sessions and then switched to 39 HD sessions with BVT (HD-BVT). The staff interventions related to IDH were monitored by a trained staff. Dialysis sessions complicated by IDH and staff interventions were affected by BVT (HD: 102 and 127 vs. HD-BVT: 57 and 59, respectively, for both p<0.001). The time consumed by staff in IDH management was decreased by HD-BVT (1416 vs. 578 min, p<0.001). The effectiveness of BVT to reduce the frequency of IDH leads to a reduction of the dialysis staff workload with fewer staff interventions, allowing for major work-time saving.

Efficacy of hemocontrol biofeedback system in intradialytic hypotension-prone hemodialysis patients.

We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9 ± 5.8 sessions, 62.1% in period A vs 9.2 ± 7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96 ± 0.66 in period A vs 0.56 ± 0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.