Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from ...Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from multifactorial interactions,including excessive ultrafiltration rates(UFR),rapid osmotic shifts,impaired vascular resistance,and comorbidities such as diabetes and cardiovascular disease.It triggers hypovolemic stress,leading to myocardial stunning,cerebral ischemia,and organ dysfunction.Non-modifiable risk factors,including age and preexisting conditions,exacerbate susceptibility,while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes.In this review,we aim to conduct an in-depth analysis of IDH,exploring its clinical relevance,underlying mechanisms,risk factors,and management approaches.Additionally,we advocate for a standardised definition and propose a strategic framework to guide future research efforts.Effective management requires individualised approaches,including optimised UFR,cooled dialysate,and nutritional adjustments,alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction.A multidisciplinary team approach,incorporating nephrologists,nurses,and dietitians,is essential for holistic patient care.Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact,ultimately improving patient outcomes and survival.展开更多
Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideli...Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideline websites,and professional society websites were systematically searched for literature on intradialytic hypotension guidance,including clinical decisions,guidelines,evidence summaries,systematic reviews,and expert consensuses,from database inception to October 1,2024.Evidence was extracted after literature quality evaluation.Results:A total of 11 publications were included:2 clinical decisions,7 guidelines,1 systematic review,and 1 expert consensus.38 pieces of evidence were summarized across 4 themes:pre-dialysis assessment and prevention,monitoring and management during dialysis,medication use,and patient self-management.Conclusion:The best evidence for prevention and management of intradialytic hypotension in maintenance hemodialysis patients is scientific and comprehensive.Healthcare professionals are advised to apply this evidence judiciously in conjunction with clinical realities to ensure patient safety.展开更多
<strong>Introduction:</strong> Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. <strong>Method:</strong> Prospective clinical-observation...<strong>Introduction:</strong> Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. <strong>Method:</strong> Prospective clinical-observational study to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH. <strong>Results:</strong> Of the 240 patients, those who had IDWG ≥ 4%, 81% had at least one hospital admission due to volume-overload or the need for extra HD-session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p < 0.001). Of those who were admitted (over 12 months) due to volume overload;74.1% had IDWG ≥ 4%, while 25.9% had IDWG < 4% (p < 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p < 0.001). When analyzing those who had at least one IDH episode/week;72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG < 4% (p < 0.001). <strong>Conclusion:</strong> In HD patients, the frequency of hospital admission due to volume-overload and the need for extra HD-sessions is strongly related to the amount of IDWG (>4% in our patients), the same stands for the frequency of IDH. Thus, control of IDWG in HD patients is of great importance, keeping in mind the importance of the nutrition status of HD patients that may also impact IDWG.展开更多
Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% an...Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% and possibly in up to 50% of dialysis sessions. IDH augments mortality essentially due to chronic overhydration and the inability to reach the proper dry weight. On-line hemodiafiltration (ol-HDF) has been reported to reduce the frequency of IDH. The aim of this study was to assess the effect of ol-HDF on hemodynamic stability and dry weight adjustment compared with low-flux HD. Methods: IDH-prone HD patients at our center were enrolled. This study was designed as a crossover trial with two phases (A arm: low-flux HD for 8 weeks followed by ol-HDF for 8 weeks vs. B arm: ol-HDF for 8 weeks followed by low-flux HD for 8 weeks) and two treatment arms (ol-HDF vs. low-flux HD), each phase lasting 8 weeks. We measured the proportion of body water using a body composition monitor (BCM). Results: In a comparison of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions from the baseline blood pressure between the HD and ol-HDF groups, statistically significant differences were observed only in the SBP of the B arm (SBP: HD vs. HDF, -9.83 ± 6.64 vs. -4.62 ± 1.61 mmHg, p = 0.036;DBP: HD vs. HDF, -3.29 ± 4.05 vs. -1.86 ± 1.49 mmHg, p = 0.261). Neither the mean of the interdialytic body weight gains nor the frequency of IDH was different between the A and B arms (p = 0.817 and p = 0.562, respectively). In terms of dialysis modality, there were no significant differences in the amount of overhydration between the conventional HD and ol-HDF groups during the two study phases, as measured by the BCM (A arm: p = 0.875, B arm: p = 0.655). Conclusion: Our study did not show a better benefit of ol-HDF to reach the dry weight compared with low-flux HD in IDH-prone patients.展开更多
Introduction: Dialytic high blood pressure (DHBP), although often ignored, is now recognized as a recurring and persistent phenomenon in a subgroup of hemodialysized patients. Its occurrence is associated with an incr...Introduction: Dialytic high blood pressure (DHBP), although often ignored, is now recognized as a recurring and persistent phenomenon in a subgroup of hemodialysized patients. Its occurrence is associated with an increased risk of hospitalization and death. The objective of the study was to determine the prevalence of intradialytic hypertension and the factors associated with it. Methods: Study was cross-sectional, monocentric, descriptive and analytical over a three-month period from April 22 to July 22, 2019. Included were all patients 18 years of age or older, chronic hemodialysis for at least three months, with intra-dialytic high blood pressure. The blood pressure machine used for the majority of patients was an electronic “OMRON” blood pressure monitor. Epidemiological, clinical, para clinical and dialysis parameters were studied. The data were collected, captured and analyzed using IBM SPSS Statistics Version 20 software. The factors associated with intradialytic high blood pressure were searched using a univariate logistic regression model. The significance threshold for all statistical tests has been set at 5%. Results: Of our 131 patients, 53 had intradialytic hypertension, a frequency of 40.5%. The time of (DHBP) occurrence was more frequent at the 3rd and 2nd hour, 94.34% and 86.79%, respectively. The average age of patients was 45.51 years with extremes ranging from 19 to 70 years. The average Systolic Blood Pressure (SBP) before dialysis was 148 mm Hg ?16.62 and the average Diastolic Blood Pressure (DBP) before dialysis was 88 mm Hg ?12.50. Pre-dialysis Blood Pressure—140/90 mm Hg was noted in 18 cases, or 34.0%. The intradialytic average SBP was 164 mm Hg ?17.25 with extremes of 121 to 202 mm Hg. The intradialytic average DBP was 92 mm Hg ?12.52 with extremes 67 to 124 mm Hg. The main risk factors associated with intra-dialytic hyperation were: Age range (40 - 50 years), Duration on dialysis (Conclusion: This study, the first of its kind in Guinea, was able to determine the frequency of intradialytic hypertension and the factors associated with it.展开更多
<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the e...<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. <strong>Methods.</strong> We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. <strong>Results.</strong> Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. <strong>Conclusion.</strong> Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.展开更多
Introduction: Intradialytic hypertension is defined as elevation of blood pressure to more than 10 mmHg in the post-dialysis period as compared to the pre-dialysis one. It is an important factor of morbidity and morta...Introduction: Intradialytic hypertension is defined as elevation of blood pressure to more than 10 mmHg in the post-dialysis period as compared to the pre-dialysis one. It is an important factor of morbidity and mortality in hemodialysis patients. The aim of our study is to assess the prevalence and associated factors of intradialytic hypertension. Patients and methods: This is a descriptive and analytical cross-sectional study that was conducted over a period of 3 weeks in the hemodialysis units of Aristide Le Dantec Hospital in Dakar and Regional Hospital Center in Ziguinchor. Chronic he-modialysis patients who are at least 18 years old and agreed to participate in study have been included. Patients who did not have 4 measures or those who decided to withdraw from the study were excluded. Intradialytic hypertension was restrained by an increase in systolic blood pressure immediately after the hemodialysis session > 10 mmHg compared to that recorded before session, with a repetition of this phenomenon for at least 4 hemodialysis sessions. Results: Our study included 539 hemodialysis sessions for 93 hemodialysis patients with a mean age of 48.72 ± 14.06 years and a sex ratio (M/F) of 1.21. The mean duration of dialysis was 64.22 ± 45.63 months. Hypertensive nephropathy was significantly common, noted in 38.7% (36 patients). Mean inter dialytic weight gain was 2.04 ± 1.06 kg, and the average dry weight was 62.71 ± 13.69 kg. The average hemoglobin level was 9.27 ± 1.91 g/dl. The mean albumin level was 35.4 ± 7.48 g/l. Nineteen (19) patients were administered erythropoietin stimulating agents (20.4%), and 59 patients were given antihypertensive drugs (63.4%). An elevation of more than 10 mmHg of post-dialysis BP compared to pre-dialysis was noted in 179 sessions, which is 33.2 per 100 hemodialysis sessions. IDH was noted in 21 patients, which represents 22.6%. The factors associated with IDH were as follows: high post-dialysis pulse pressure (PP) (p = 0.0008), pre-dialysis systolic-diastolic hypertension (p = 0.004), pre-dialysis pure systolic hypertension (p = 0.01), post-dialysis hypertension (p = 0.02), and hypoalbuminemia (p = 0.049). Conclusion: Although recognized for many years, the intradialytic hypertension is often neglected. However, it is common in our cohort of chronic hemodialysis with several associated factors. Its management is essential and will necessarily pass through adequate management of the blood volume.展开更多
Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on mainte...Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on maintenance hemodialysis in Cameroon. Method: It was a prospective cohort study including end stage kidney disease patients on HD. Data collected were: socio-demographic, comorbidities, current medication, weight, heart rate ultrafiltration rate (UF), albuminemia and electrocardiogram. The first blood pressure (BP) measurement was obtained at the beginning of the session and the last at the end. IDH was defined as an increase in systolic BP ≥ 10 mmHg between the first and the last measurement. Logistic regression was used to look for associated factors, p-value Results: Mean age was 49.06 ± 13.97 years with 64.2% males. Mean number of dialysis session was 11.26 ± 2.49. Incidence of IDH was 48.36%. The median number of IDH episodes was 5 (Range 0 - 12). Factors increasing the risk were hypertension (p = 0.003), number of antihypertensive drugs ≥ 2 (p Conclusion: IDH is frequent amongst patients on maintenance hemodialysis in our setting, with various patients related factors associated.展开更多
The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affect...The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and effcacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confrm the encouraging outcomes mentioned here.展开更多
文摘Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from multifactorial interactions,including excessive ultrafiltration rates(UFR),rapid osmotic shifts,impaired vascular resistance,and comorbidities such as diabetes and cardiovascular disease.It triggers hypovolemic stress,leading to myocardial stunning,cerebral ischemia,and organ dysfunction.Non-modifiable risk factors,including age and preexisting conditions,exacerbate susceptibility,while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes.In this review,we aim to conduct an in-depth analysis of IDH,exploring its clinical relevance,underlying mechanisms,risk factors,and management approaches.Additionally,we advocate for a standardised definition and propose a strategic framework to guide future research efforts.Effective management requires individualised approaches,including optimised UFR,cooled dialysate,and nutritional adjustments,alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction.A multidisciplinary team approach,incorporating nephrologists,nurses,and dietitians,is essential for holistic patient care.Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact,ultimately improving patient outcomes and survival.
文摘Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideline websites,and professional society websites were systematically searched for literature on intradialytic hypotension guidance,including clinical decisions,guidelines,evidence summaries,systematic reviews,and expert consensuses,from database inception to October 1,2024.Evidence was extracted after literature quality evaluation.Results:A total of 11 publications were included:2 clinical decisions,7 guidelines,1 systematic review,and 1 expert consensus.38 pieces of evidence were summarized across 4 themes:pre-dialysis assessment and prevention,monitoring and management during dialysis,medication use,and patient self-management.Conclusion:The best evidence for prevention and management of intradialytic hypotension in maintenance hemodialysis patients is scientific and comprehensive.Healthcare professionals are advised to apply this evidence judiciously in conjunction with clinical realities to ensure patient safety.
文摘<strong>Introduction:</strong> Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. <strong>Method:</strong> Prospective clinical-observational study to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH. <strong>Results:</strong> Of the 240 patients, those who had IDWG ≥ 4%, 81% had at least one hospital admission due to volume-overload or the need for extra HD-session(s). On the other hand, only 19% of those having IDWG < 4% had been admitted or got extra HD sessions (p < 0.001). Of those who were admitted (over 12 months) due to volume overload;74.1% had IDWG ≥ 4%, while 25.9% had IDWG < 4% (p < 0.001). Regarding IDH, 87% of patients having IDWG ≥ 4% had at least one episode of IDH/week. On the other hand, only 22.5% of those with IDWG < 4% had one episode of IDH/week (p < 0.001). When analyzing those who had at least one IDH episode/week;72.9% of them had IDWG ≥ 4%, while only 27.1% had IDWG < 4% (p < 0.001). <strong>Conclusion:</strong> In HD patients, the frequency of hospital admission due to volume-overload and the need for extra HD-sessions is strongly related to the amount of IDWG (>4% in our patients), the same stands for the frequency of IDH. Thus, control of IDWG in HD patients is of great importance, keeping in mind the importance of the nutrition status of HD patients that may also impact IDWG.
文摘Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% and possibly in up to 50% of dialysis sessions. IDH augments mortality essentially due to chronic overhydration and the inability to reach the proper dry weight. On-line hemodiafiltration (ol-HDF) has been reported to reduce the frequency of IDH. The aim of this study was to assess the effect of ol-HDF on hemodynamic stability and dry weight adjustment compared with low-flux HD. Methods: IDH-prone HD patients at our center were enrolled. This study was designed as a crossover trial with two phases (A arm: low-flux HD for 8 weeks followed by ol-HDF for 8 weeks vs. B arm: ol-HDF for 8 weeks followed by low-flux HD for 8 weeks) and two treatment arms (ol-HDF vs. low-flux HD), each phase lasting 8 weeks. We measured the proportion of body water using a body composition monitor (BCM). Results: In a comparison of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions from the baseline blood pressure between the HD and ol-HDF groups, statistically significant differences were observed only in the SBP of the B arm (SBP: HD vs. HDF, -9.83 ± 6.64 vs. -4.62 ± 1.61 mmHg, p = 0.036;DBP: HD vs. HDF, -3.29 ± 4.05 vs. -1.86 ± 1.49 mmHg, p = 0.261). Neither the mean of the interdialytic body weight gains nor the frequency of IDH was different between the A and B arms (p = 0.817 and p = 0.562, respectively). In terms of dialysis modality, there were no significant differences in the amount of overhydration between the conventional HD and ol-HDF groups during the two study phases, as measured by the BCM (A arm: p = 0.875, B arm: p = 0.655). Conclusion: Our study did not show a better benefit of ol-HDF to reach the dry weight compared with low-flux HD in IDH-prone patients.
文摘Introduction: Dialytic high blood pressure (DHBP), although often ignored, is now recognized as a recurring and persistent phenomenon in a subgroup of hemodialysized patients. Its occurrence is associated with an increased risk of hospitalization and death. The objective of the study was to determine the prevalence of intradialytic hypertension and the factors associated with it. Methods: Study was cross-sectional, monocentric, descriptive and analytical over a three-month period from April 22 to July 22, 2019. Included were all patients 18 years of age or older, chronic hemodialysis for at least three months, with intra-dialytic high blood pressure. The blood pressure machine used for the majority of patients was an electronic “OMRON” blood pressure monitor. Epidemiological, clinical, para clinical and dialysis parameters were studied. The data were collected, captured and analyzed using IBM SPSS Statistics Version 20 software. The factors associated with intradialytic high blood pressure were searched using a univariate logistic regression model. The significance threshold for all statistical tests has been set at 5%. Results: Of our 131 patients, 53 had intradialytic hypertension, a frequency of 40.5%. The time of (DHBP) occurrence was more frequent at the 3rd and 2nd hour, 94.34% and 86.79%, respectively. The average age of patients was 45.51 years with extremes ranging from 19 to 70 years. The average Systolic Blood Pressure (SBP) before dialysis was 148 mm Hg ?16.62 and the average Diastolic Blood Pressure (DBP) before dialysis was 88 mm Hg ?12.50. Pre-dialysis Blood Pressure—140/90 mm Hg was noted in 18 cases, or 34.0%. The intradialytic average SBP was 164 mm Hg ?17.25 with extremes of 121 to 202 mm Hg. The intradialytic average DBP was 92 mm Hg ?12.52 with extremes 67 to 124 mm Hg. The main risk factors associated with intra-dialytic hyperation were: Age range (40 - 50 years), Duration on dialysis (Conclusion: This study, the first of its kind in Guinea, was able to determine the frequency of intradialytic hypertension and the factors associated with it.
文摘<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. <strong>Methods.</strong> We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. <strong>Results.</strong> Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. <strong>Conclusion.</strong> Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.
文摘Introduction: Intradialytic hypertension is defined as elevation of blood pressure to more than 10 mmHg in the post-dialysis period as compared to the pre-dialysis one. It is an important factor of morbidity and mortality in hemodialysis patients. The aim of our study is to assess the prevalence and associated factors of intradialytic hypertension. Patients and methods: This is a descriptive and analytical cross-sectional study that was conducted over a period of 3 weeks in the hemodialysis units of Aristide Le Dantec Hospital in Dakar and Regional Hospital Center in Ziguinchor. Chronic he-modialysis patients who are at least 18 years old and agreed to participate in study have been included. Patients who did not have 4 measures or those who decided to withdraw from the study were excluded. Intradialytic hypertension was restrained by an increase in systolic blood pressure immediately after the hemodialysis session > 10 mmHg compared to that recorded before session, with a repetition of this phenomenon for at least 4 hemodialysis sessions. Results: Our study included 539 hemodialysis sessions for 93 hemodialysis patients with a mean age of 48.72 ± 14.06 years and a sex ratio (M/F) of 1.21. The mean duration of dialysis was 64.22 ± 45.63 months. Hypertensive nephropathy was significantly common, noted in 38.7% (36 patients). Mean inter dialytic weight gain was 2.04 ± 1.06 kg, and the average dry weight was 62.71 ± 13.69 kg. The average hemoglobin level was 9.27 ± 1.91 g/dl. The mean albumin level was 35.4 ± 7.48 g/l. Nineteen (19) patients were administered erythropoietin stimulating agents (20.4%), and 59 patients were given antihypertensive drugs (63.4%). An elevation of more than 10 mmHg of post-dialysis BP compared to pre-dialysis was noted in 179 sessions, which is 33.2 per 100 hemodialysis sessions. IDH was noted in 21 patients, which represents 22.6%. The factors associated with IDH were as follows: high post-dialysis pulse pressure (PP) (p = 0.0008), pre-dialysis systolic-diastolic hypertension (p = 0.004), pre-dialysis pure systolic hypertension (p = 0.01), post-dialysis hypertension (p = 0.02), and hypoalbuminemia (p = 0.049). Conclusion: Although recognized for many years, the intradialytic hypertension is often neglected. However, it is common in our cohort of chronic hemodialysis with several associated factors. Its management is essential and will necessarily pass through adequate management of the blood volume.
文摘Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on maintenance hemodialysis in Cameroon. Method: It was a prospective cohort study including end stage kidney disease patients on HD. Data collected were: socio-demographic, comorbidities, current medication, weight, heart rate ultrafiltration rate (UF), albuminemia and electrocardiogram. The first blood pressure (BP) measurement was obtained at the beginning of the session and the last at the end. IDH was defined as an increase in systolic BP ≥ 10 mmHg between the first and the last measurement. Logistic regression was used to look for associated factors, p-value Results: Mean age was 49.06 ± 13.97 years with 64.2% males. Mean number of dialysis session was 11.26 ± 2.49. Incidence of IDH was 48.36%. The median number of IDH episodes was 5 (Range 0 - 12). Factors increasing the risk were hypertension (p = 0.003), number of antihypertensive drugs ≥ 2 (p Conclusion: IDH is frequent amongst patients on maintenance hemodialysis in our setting, with various patients related factors associated.
文摘The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and effcacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confrm the encouraging outcomes mentioned here.
