Intradialytic Hypotension Research Articles

Hemodialysis Experience After Kahramanmaraş Earthquake

Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (n = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (n = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (n = 15). Results: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. Conclusions: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment.

Intradialytic Hypotension: An Often Neglected and Common Hemodialysis Complication Affecting Quality of Life in Patients

The Article Abstract is not available.

Plasma Refill Rate and Intradialytic Hypotension during Hemodialysis in Hospitalized Patients

Plasma Refill Rate and Intradialytic Hypotension during Hemodialysis in Hospitalized Patients

Randomized trial demonstrating no translocation of intact intestinal bacteria during hemodialysis or hemodiafiltration

IntroductionThe low incidence of intradialytic hypotension (IDH) in high-volume (HV) hemodiafiltration (HDF) may help maintaining gut perfusion during treatment. Preservation of gut endothelial integrity would limit or prevent bacterial translocation and subsequent systemic inflammation, which may contribute to the low mortality rate in HV-HDF. MethodsForty patients were cross-over randomized to S-HD, cool HD (C-HD) and HDF (low-volume [LV] and HV, convection volumes 15 L resp. ≥23 L/session), each for 2 weeks. Quantitative assessment of microbial DNA (mDNA) in blood was performed before and after dialysis by 16S-23S interspace profiling after DNA isolation. The intradialytic acute phase response (APR) was evaluated by high-sensitivity CRP (hs-CRP), IL-6 receptor (IL-6R), soluble CD14 (sCD14) and vascular-cell-adhesion molecule-1 (VCAM-1). Differences between modalities were primary objectives. ResultsMDNA was absent in all samples. IL-6R, sCD14, and VCAM-1 increased equally in all modalities (median increase resp.: 12.5%, 14.0%, 14.8%, P<0.05). Hs-CRP increased only in C-HD and HV-HDF (median increase: 12.6%, P<0.05). After correction for hemoconcentration, most APR-markers decreased (median: sCD14 -11.3% and VCAM-1 -14.4% in all modalities; IL-6R -13.4% in C-HD, LV- and HV-HDF; P<0.05). Hs-CRP only decreased in C-HD (-13.5%, P=0.004). Conclusions1) Circulating mDNA could not be demonstrated; 2) while in the crude analysis a similar APR was noted in all modalities, individual markers remained stable or declined after correction for hemoconcentration; 3) as neither bacterial translocation nor an APR was observed in either modality, it is highly unlikely that the superior survival of HV-HDF is explained by superior preservation of gut integrity.

Predictors of Intradialytic Hypotension in Critically Ill Patients Undergoing Kidney Replacement Therapy: A Systematic Review

Predictors of Intradialytic Hypotension in Critically Ill Patients Undergoing Kidney Replacement Therapy: A Systematic Review

Forecasting Intradialytic Hypotension: A Comparative Analysis of Machine-Learning and Deep-Learning Approaches

Forecasting Intradialytic Hypotension: A Comparative Analysis of Machine-Learning and Deep-Learning Approaches

Pharmacologic and Nonpharmacologic Management of Intradialytic Hypotension in ESKD: A Systematic Review and Meta-Analysis

Pharmacologic and Nonpharmacologic Management of Intradialytic Hypotension in ESKD: A Systematic Review and Meta-Analysis

Real-Time Forecasting of Intradialytic Hypotension Using Deep Learning and Multimodal Data Integration

Real-Time Forecasting of Intradialytic Hypotension Using Deep Learning and Multimodal Data Integration

Predicting intradialytic hypotension in critically ill patients undergoing intermittent hemodialysis: a prospective observational study

BackgroundHypotension during dialysis arises from vasomotor tone alterations and hypovolemia, with disrupted counterregulatory mechanisms in acute kidney injury (AKI) patients. This study investigated the predictive value of preload dependency, assessed by the passive leg raising (PLR) test, and arterial tone, measured by dynamic elastance (Eadyn), for intradialytic hypotension (IDH).MethodsIn this prospective observational study conducted in a tertiary hospital ICU, hemodynamic parameters were collected from critically ill AKI patients undergoing intermittent hemodialysis using the FloTrac/Vigileo system. Baseline measurements were recorded before KRT initiation, including the PLR test and Eadyn calculation. IDH was defined as mean arterial pressure (MAP) < 65 mmHg during dialysis. Logistic regression was used to identify predictors of IDH, and Kaplan–Meier analysis assessed 90-day survival.ResultsOf 187 patients, 27.3% experienced IDH. Preload dependency, identified by positive PLR test, was significantly associated with IDH (OR 8.54, 95% CI 5.25–27.74), while baseline Eadyn was not predictive of IDH in this cohort. Other significant predictors of IDH included norepinephrine use (OR 16.35, 95% CI 3.87–68.98) and lower baseline MAP (OR 0.96, 95% CI 0.94–1.00). IDH and a positive PLR test were associated with lower 90-day survival (p < 0.001).ConclusionsThe PLR test is a valuable tool for predicting IDH in critically ill AKI patients undergoing KRT, while baseline Eadyn did not demonstrate predictive value in this setting. Continuous hemodynamic monitoring, including assessment of preload dependency, may optimize patient management and potentially improve outcomes. Further research is warranted to validate these findings and develop targeted interventions to prevent IDH.

Construction and Explanation Analysis of a Hypotension Risk Prediction Model in Hemodialysis Based on Machine Learning

Objective. To establish a risk prediction model for intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients and to analyze the explainability of the risk prediction model. Methods. A total of 2,228,650 hemodialysis records of 1075 MHD patients were selected as the research objects. Thirteen important clinical features including demographic features and clinical features were screened, the blood pressure measured before hemodialysis was collected, then an IDH risk prediction model during hemodialysis was established based on a machine learning algorithm. The contribution of each feature to the risk prediction of IDH was measured based on the Gini evaluation index. The TreeSHAP method was used to provide global and individual explanations for the IDH risk prediction model. Results. Hemodialysis duration, pre-dialysis mean arterial pressure, and pre-dialysis systolic blood pressure were the most important predictive variables for the occurrence of IDH during hemodialysis in MHD patients. The best IDH risk prediction model based on machine learning had an accuracy of 0.92 (95% CI 0.90–0.94) and an AUC of 0.95 (95% CI 0.94–0.96), indicating that machine learning has a good effect on the prediction of IDH during hemodialysis treatment. Our research innovatively achieved IDH risk prediction during the entire hemodialysis period based on blood pressure before the start of hemodialysis and other clinical features, thus enabling the medical team to quickly adjust hemodialysis prescriptions or initiate treatment for timely management and prevention of IDH. Global and individual explanations of the IDH risk prediction model can help hemodialysis medical staff understand the overall prediction mechanism of the model, discover prediction outliers, and identify potential biases or errors in the model. Conclusions. The IDH risk prediction model has definite clinical value in actual hemodialysis treatment.

Prediction models for intradialytic hypotension in hemodialysis patients: A protocol for systematic review and critical appraisal.

Intradialytic hypotension (IDH) is common in hemodialysis patients and can lead to several complications. Risk factors for IDH include demographic characteristics, comorbidities, dialysis procedure factors, and so on. Clinical studies on predictive models for dialysis-induced hypotension have shown inconsistent results. This systematic review aims to evaluate published prediction models for IDH, analyzing their characteristics, predictors, efficacy, and the methodological quality and applicability. The protocol has been prepared using the Preferred Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines. The systematic review protocol for IDH prediction in hemodialysis patients has been registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY2023110081, DOI: 10.37766/inplasy2023.11.0081). A comprehensive search across five major databases (PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang) will be conducted for studies on prediction models of IDH among hemodialysis patients. Two researchers will independently screen literature, extract data, and evaluate the bias risk and applicability of included studies using prediction modelling study tools. This systematic review will provide critical insights into the efficacy and quality of reporting of the IDH model in hemodialysis patients. This will guide clinical staff in selecting the most appropriate IDH prediction model and inform future research endeavors in IDH prediction.

Intradialytic Hypotension in the Face of Using Different Antihypertensive Medication Classes.

Intradialytic Hypotension in the Face of Using Different Antihypertensive Medication Classes.

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

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&lt;0.001), femalesex (H/F ratio of 0.5 vs. 1.1, P&lt;0.001), diabetes (47.4% vs. 44%, P&lt;0.001), lowpre-dialyticnatremia (134 ± 14 vs. 136 ± 10 mmol/l, P&lt;0.001), and underestimated dry weight (70.6 ± 12.5 vs. 73 ± 14.2 kg, P&lt;0.001). Sessions with bolus infusion werecharacterized by a low total effective UF volume (2000 ± 870 ml vs. 2285.8 ± 854.8, P&lt;0.001), shorter duration withpremature session disconnection (209 ± 25 min vs. 235 ± 7 min, P=0.02), and loweraveragedialysatetemperature (P&lt;0.001). The final relative blood volume washigher (87 ± 9 vs. 82 ± 9, P&lt;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.

Intradialytic eating practices and health outcomes among hemodialysis patients, cross-sectional study

Intradialytic eating practices is a subject of debate among hemodialysis patients and is associated with a variety of clinical implications. This study aimed to investigate eating practices during hemodialysis and their influence on health outcome, including various symptoms experienced during dialysis, intradialytic hypotension, dialysis adequacy, and malnutrition. A cross-sectional study was conducted on hemodialysis patients. A structured questionnaire was used to collect information related to sociodemographic, medical history, lifestyle, dialysis, and eating practices. The occurrence of intradialytic hypotension was determined according to the patients' blood pressure measured at the beginning and end of the session, and dialysis adequacy was determined based on the ultrafiltration rate of the patients. Malnutrition was evaluated using renal inpatient screening tool (renal iNUT), and biochemical data was recruited from the patient's hospital records. A total of 260 hemodialysis patients participated in this study. The mean age was 51.29±15.92, and half of the participants were females. The findings showed no significant association between intradialytic eating practices and symptoms developed during dialysis session, intradialytic hypotension, or malnutrition (p>0.05). According to Chi-square test, a statistically significant association was found between eating practices and dialysis adequacy (p=0.037), hemoglobin level (p<0.001), and phosphorous level (p=0.003). Eating practices were not associated with symptoms that developed during dialysis sessions, intradialytic hypotension, or malnutrition, according to our findings. However, findings reveal that it is possible that eating practices may affect the adequacy of dialysis.

The effect of changes in intra-compartmental bioimpedance measurements with early intra-dialytic hypotension during haemodialysis.

Intra-dialytic hypotension (IDH) remains the commonest problem associated with routine haemodialysis treatments. Fluid shifts from intracellular(ICW) and extracellular(ECW) compartments to refill plasma volume during haemodialysis with ultrafiltration. We studied the effect of relative changes in ICW and ECW indifferent body segments using multifrequency segmental bioimpedance during haemodialysis and IDH episodes. Of 42 haemodialysis patients,16 patients (38.1%) developed IDH within the first hour of dialysis. Patients with and without early IDH were well-matched for demographics and starting bioimpedance measurements. However, after 60 min, the relative change in in ECW/ICW ratio between the non-fistula arm and leg was significantly different for the early IDH group median -1.07 (-3.33 to 0.8) versus 0.61 (-0.78 to 1.8), p < 0.05, whereas there no differences in ultrafiltration rate, relative blood volume monitoring or on-line clearance. Monitoring serial changes in fluid status in different body compartments with bioimpedance may potentially prevent IDH in the future.

Achievement of fluid removal targets during intermittent renal replacement therapy in the intensive care unit

ABSTRACT Background In patients with acute kidney injury (AKI), fluid balance management often relies on the prescription and achievement of fluid removal using intermittent renal replacement therapy (IRRT). This study aimed to describe characteristics associated with the failure to achieve target fluid removal (FATFR). Methods This is a retrospective cohort study including IRRT sessions of conventional duration (&amp;lt;5 hours) performed for AKI in the intensive care unit (ICU) from 2017 to 2022 at a tertiary academic center. FATFR-50% was defined as fluid removal of &amp;lt;50% of the prescribed target. Characteristics of patients and sessions, as well as outcomes at 90 days were collected. The causes of FATFR were manually adjudicated. Results A total of 291 patients and 1280 IRRT sessions in the ICU were included. FATFR-50% occurred in 7.3% of sessions and 19.2% of patients had at least one session with FATFR-50% during the first week of IRRT. Sessions with FATFR-50% were characterized by a higher occurrence of intradialytic hypotension (24.2% vs 60.2%, P &amp;lt; .001) and a higher planned fluid removal (6.19 vs 5.27 m/kg/h, P = .02). Multiple episodes of FATFR-50% were associated with a positive cumulative fluid balance (β 3876 (CI 2053–5899) P &amp;lt; .001). At 90-day follow-up, FATFR-50% during the first week after IRRT initiation was independently associated with fewer ICU- and hospital-free days, as well as with a higher risk of mortality (odds ratio 2.01 CI 1.04–3.89, P = .04). Conclusions FATFR occurs in about one out of five critically ill patients within the first week of IRRT and is associated with adverse clinical outcomes.

Closed Loop Ultrafiltration Feedback Control in Hemodialysis: A Narrative Review.

While life-sustaining, hemodialysis is a non-physiological treatment modality that exerts stress on the patient, primarily due to fluid shifts during ultrafiltration. Automated feedback control systems, integrated with sensors that continuously monitor bio-signals such as blood volume, can adjust hemodialysis treatment parameters, e.g., ultrafiltration rate, in real-time. These systems hold promise to mitigate hemodynamic stress, prevent intradialytic hypotension, and improve the removal of water and electrolytes in chronic hemodialysis patients. However, robust evidence supporting their clinical application remains limited. Based on an extensive literature research, we assess feedback-controlled ultrafiltration systems that have emerged over the past three decades in comparison to conventional hemodialysis treatment. We identified 28 clinical studies. Closed loop ultrafiltration control demonstrated effectiveness in 23 of them. No adverse effects of closed loop ultrafiltration control were reported across all trials. Closed loop ultrafiltration control represents an important advancement towards more physiological hemodialysis. Its development is driven by innovations in real-time bio-signals monitoring, advancement in control theory, and artificial intelligence. We expect these innovations will lead to the prevalent adoption of ultrafiltration control in the future, provided its clinical value is substantiated in adequately randomized controlled trials.

Effect of Pre- and Post-Dialysis Exercise on Functional Capacity Using Portable Ergometer in Chronic Kidney Disease Patients.

To assess whether performing exercises during hemodialysis reduces the risk of developing intradialytic hypotension and enhances exercise capacity in patients with chronic kidney disease. This study included patients aged ≥18 years undergoing hemodialysis. Participants performed exercises using a portable lower extremity ergometer during hemodialysis sessions for 3 weeks. Data regarding walking distance, knee strength, quality of life, fat-free mass, arterial pressure, blood pressure, heart rate, frequency of intradialytic hypotension, fatigue, and duration of hemodialysis were collected and analyzed. Significant improvements in walking distance and knee strength were observed following the implementation of exercise training during hemodialysis. Although there was no significant reduction in the frequency of intradialytic hypotension, a decreasing trend was noted. Other parameters such as quality of life and fatigue did not show significant changes. Using a portable ergometer during hemodialysis improved exercise capacity and knee strength in patients with chronic kidney disease. There was a trend toward reduced intradialytic hypotension, suggesting potential cardiovascular benefits. Further research with larger sample sizes is needed to confirm these findings.

Online Hemodiafiltration: A New Perspective for Patients With End-Stage Renal Disease.

Introduction Online hemodiafiltration (OL-HDF) is the most effective renal replacement therapy (RRT), which allows the enhanced removal of small and large uremic toxins by combining diffusion and convective transport of solutes. Although the goal of OL-HDF is to provide greater clearance of solutes with a preference for intermediate molecules responsible for many of the complications of chronic kidney disease (CKD), the studies reported to date and their meta-analyses are conflicting in nature and do not show a significant advantage of convective therapies on patient prognosis. Materials and methods At the Clinic of Nephrology and Dialysis, University Hospital "St. Marina", Varna, Bulgaria, 41 patients were monitored in a retrospective study for a two-year period, randomized into two groups, conducting OL-HDF after dilution and hemodialysis (HD) with the aim of studying the effect of convective therapies on the clinical outcome, the achieved quality of life, and the prognosis of the patient. Results The study found a significantly higher quality of life in patients undergoing OL-HDF with significantly higher values ​​of indicators of dialysis adequacy and nutritional status, better control of the anemic syndrome with the reduction of erythropoietin doses, significantly lower frequency of episodes of intradialytic hypotension with improved recovery, and 3.6-fold lower risk of death compared with conventional dialysis. Discussion Three major randomized controlled trials have compared survival outcomes in patients receiving HD or post-dilution OL-HDF, reporting conflicting results. Meta-analyses of the published studies have also been unable to provide a clear and definitive answer regarding the potential benefits of choosing one treatment over the other. Overall mortality, anemia, phosphate control, and small molecule clearance appear to be insufficiently influenced by the treatment method. On the other hand, cardiovascular mortality, hemodynamic stability, and clearance of middle and protein-bound molecules seem to be better in patients treated with OL-HDF. Conclusions Despite the conflicting data reported so far, OL-HDF is associated with better clinical outcome and prognosis for end-stage renal disease (ESRD) patient and undoubtedly warrants extensive future study with a view to improved quality of life in the growing dialysis population.

Antihypertensive Drug Treatment and the Risk for Intrahemodialysis Hypotension.

Antihypertensive medications are often prescribed to manage hypertension in hemodialysis (HD) patients, and intradialytic hypotension (IDH) is a common complication in these patients. We investigated the risk of IDH in incident HD patients who initiated treatment with antihypertensive drugs in monotherapy. The study was conducted as an emulation of a randomized clinical trial in 4072 incident HD patients who started anti-hypertensive drug treatment between January 2016 to December 2019. The primary outcome was the occurrence of IDH during HD sessions. The Gener alised Estimating Equation (GEE) analysis was adjusted by inverse probability treatment weighting (IPTW). Calcium channel blocker (CCB) use was associated with an IDH incidence rate of 7.4 events per person-year (95% CI: 6.2-8.6). Compared to CCB use, use of beta and alpha-beta blockers was strongly associated with a higher likelihood of IDH (OR [95% CI] 2.27 [1.50-3.43]). Use of angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (OR [95% CI] 1.71 [1.14-2.57]) and diuretics (OR [95% CI] 1.52 [1.07-2.16]) were also associated with higher likelihood of IDH compared to CCB use. The study suggests that using beta and alpha-beta blockers, ACE inhibitors or angiotensin II receptor blockers, and diuretics may increase the risk of IDH in HD patients compared to CCB use.