A brief review of intradialytic hypotension with a focus on survival

Chou, Jason; Kalantar-Zadeh, Kamyar; Mathew, Anna

doi:10.1111/sdi.12627

Cited by 103 publications

(114 citation statements)

References 87 publications

(107 reference statements)

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“…Whereas the incidence of catastrophic complications during HD is relatively low, the incidence of moderate to severe intradialytic complications, mainly attributable to IDH, is high. The incidence of IDH is assumed to be around 20% but may vary between 5% and 30% based on different definitions . In a recent study assessing 44 801 treatments in 1137 patients, in which IDH was defined as a decrease in systolic blood pressure by more than 30 mm Hg to a level of less than 90 mm Hg, the incidence was 17.2% .…”

Section: Interactions Between Circulatory Thermal and Respiratory Stmentioning

confidence: 99%

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Kooman

Katzarski

Sande

et al. 2018

Seminars in Dialysis

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Hemodialysis (HD) is a lifesaving treatment for patients with end-stage renal disease, which is very efficient in the correction of abnormalities of the internal environment. However, this efficiency also induces significant hemodynamic, thermal, and respiratory stressors. These have parallels with the extreme physiologic demands which are normally mainly experienced by healthy subjects under adverse environmental conditions, with the difference that they must be endured by a vulnerable patient population. Hemodynamic stress induced by ultrafiltration leads to a decline in circulating blood volume, which may result in intradialytic hypotension (IDH) and changes in tissue perfusion, which may have long-term consequences for the function of vital organs such as the brain and the heart. Pronounced declines in central venous oxygen saturation have been observed during routine HD, which are related to the circulatory stress imposed upon the patient. Apart from patient-related factors, thermal stress induced by HD may lead to skin vasodilation, counteracting the normal hemodynamic response to hypovolemia, which has important pathophysiologic correlates in heat syncope. Lastly, respiratory stress is reflected by prolonged arterial hypoxemia during HD, which is both related to patient-related factors, but may also be partly because of the treatment itself, especially during the first 30-60 minutes. Whereas hypoxemia during HD is related to increased mortality, its role in the reduced tissue oxygen delivery during HD should be further defined. Treatment modifications, such as cool or temperature-controlled HD, may reduce circulatory and thermal stress, which also may translate into a reduced risk of long-term cardiac or cerebral damage. However, as circulatory stress is mainly time-dependent, prolonged, or more dialysis treatment may reduce the homeostatic burden on the patient.

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Section: Interactions Between Circulatory Thermal and Respiratory Stmentioning

confidence: 99%

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Kooman

Katzarski

Sande

et al. 2018

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…A recent multicentre study found an association between IDH with factors such as age, female gender, diabetes mellitus, Hispanic origin, longer dialysis vintage, higher body mass index and lower pre-dialytic SBP [2]. Also, the presence of cardiac dysfunction [6] and autonomous neuropathy [7] can increase the vulnerability for the haemodynamic effects of HD [1, 8]. …”

Section: Pathophysiology Of Idh: Patient-related Factorsmentioning

confidence: 99%

“…Depending on the definitions, IDH is reported to occur between 5and 30% also based on different definitions in varying patient populations [1]. In a recent study assessing 44,801 treatments in 1,137 patients, in which IDH was defined as a decrease in systolic blood pressure (SBP) by more than 30 mm Hg to a level of less than 90 mm Hg, the incidence was 17.2% [2].…”

Section: Introductionmentioning

confidence: 99%

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

et al. 2018

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Background: Intradialytic hypotension (IDH) is a common complication of haemodialysis (HD) and associated with adverse outcomes, especially when a nadir definition (systolic blood pressure <90 mm Hg) is used. The pathogenesis of IDH is directly linked to the discontinuous nature of the HD treatment, in combination with patient-related factors such as age, diabetes mellitus and cardiac failure. Summary: Although the decline in blood volume due to removal of fluid by ultrafiltration is the prime mover, thermally induced reflex vasodilation compromises the haemodynamic response to hypovolemia. Recent studies have stressed the relevance of changes in tissue perfusion during HD, which may translate in long-term organ damage. Monitoring changes in tissue perfusion, for which emerging evidence becomes available, appears to have great promise in the fine-tuning of the dialysis procedure. Key Messages: While it is unlikely that IDH can be completely prevented, reduction in inter-dialytic weight gain, prevention of an increase in core temperature by adjusting the dialysate temperature and more frequent or prolonged dialysis treatment remain cornerstones in providing a more comfortable and safe treatment.

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“…It can be related to fluid depletion, but it is worth noting, that just like IDH, increased thirst and dizziness it may also be related to the rapid removal of fluid (Chou et al . ).…”

Section: Discussionmentioning

confidence: 97%

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

Stenberg

Keane

Lindberg

et al. 2019

Journal of Renal Care

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SUMMARY Background About a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affect survival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedance spectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to develop and validate a decision aid combining clinical assessment of fluid status with information from BIS in target weight determination. Methods The decision aid was based on empirical experience and a literature review identifying physiological parameters already used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinary stakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessed by inter‐rater agreement analysis between nurses assessing typical patient cases. Results The decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoring system; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptoms was almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increased to moderate, with training and self‐reported confidence. Conclusion RECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations, and incorporation of bioimpedance into target weight management. However, implementation into clinical practice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response to and correction of recognised fluid alterations.

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A brief review of intradialytic hypotension with a focus on survival

Cited by 103 publications

References 87 publications

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Hemodialysis: A model for extreme physiology in a vulnerable patient population

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

Systematic Fluid Assessment in Haemodialysis: Development and Validation of A Decision Aid

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