A Randomized, Controlled Trial of Albumin versus Saline for the Treatment of Intradialytic Hypotension

Abstract

Abstract. Intradialytic hypotension (IDH) is the most common complication of hemodialysis. Symptomatic IDH requires the administration of fluid and often results in the early termination of dialysis, both of which may prevent adequate fluid removal. The optimal fluid for the treatment of IDH remains unknown. A randomized, double-blind, crossover trial was performed in 72 chronic hemodialysis patients to determine whether 5% albumin was more effective than normal saline for the treatment of IDH. The primary outcome measure was the percentage of target ultrafiltration achieved, which was defined as the actual ultrafiltration volume divided by target ultrafiltration volume. Secondary outcome measures included postdialysis BP, time to restore BP, recurrent IDH, and treatment failure (inability to restore BP with 750 ml of study fluid). The percentage of target ultrafiltration achieved was 0.84 Ϯ 0.17 for 5% albumin compared with 0.80 Ϯ 0.16 for saline (P ϭ 0.14). The postdialysis systolic BP (121 Ϯ 19 mmHg versus 117 Ϯ 19 mmHg; P ϭ 0.32), postdialysis diastolic BP (63 Ϯ 9 mmHg versus 61 Ϯ 9 mmHg; P ϭ 0.33), volume of study fluid used to treat IDH (403 Ϯ 170 ml versus 428 Ϯ 191 ml; P ϭ 0.34), time required to restore the BP (7.9 Ϯ 6.6 min versus 9.9 Ϯ 7.5 min; P ϭ 0.09), total nursing time required to manage the hypotensive episode (15.1 Ϯ 7.2 min versus 15.9 Ϯ 7.3 min; P ϭ 0.47), number of treatment failures (22% versus 24%; P ϭ 1.0), and the frequency of recurrent IDH (36% versus 36%) were not significantly different when 5% albumin was used compared with saline. It is concluded that 5% albumin is no more effective than normal saline for the treatment of IDH in chronic hemodialysis patients. Normal saline should be used as the initial fluid for the treatment of IDH.

Improving Volume Status by Comprehensive Dietary and Dialytic Sodium Management in Chronic Hemodialysis Patients

“…In stable as well as in cardiac-compromised HD patients blood volume was better preserved with albumin or hydroxyethyl starch in comparison with isotonic saline, whereas the efficacy of hydroxyethyl starch was comparable to albumin [46,47] . In a randomized crossover study in hypotensive-prone patients saline and albumin were equally effective in the treatment of hypotensive episodes [48] . Another study investigated the effects of hypertonic glucose solutions on blood volume as compared to iso-or hyperosmotic saline solutions in 6 stable HD patients and revealed that hypertonic glucose (20% glucose) resulted in a greater increase in blood volume than equal volumes of the other solutions [49] .…”

Effect of Sodium Balance and the Combination of Ultrafiltration Profile during Sodium Profiling Hemodialysis on the Maintenance of the Quality of Dialysis and Sodium and Fluid Balances

“…It is a major hindrance and has a negative impact on health-related quality of life in patients who are on the maintenance HD (2). Apart from patients' subjective discomforts, IHD often requires the early discontinuation of the dialysis session and/or the fluid replacement that results in chronic volume overload and underdialysis (3,4). Current guideline of the Dialysis Outcome Quality Initiative (DOQI) recommends that every effort be undertaken to minimize IHD that compromises the delivery of adequate dialysis (5).…”

Effect of Hemodialysis on the Hemodynamic Status for Patients with Chronic Renal Failure

“…Decreased HRV, an indicator of suppressed autonomic activity that is associated with adverse clinical events and increased mortality in patients with stable ischemic heart disease and preserved left ventricular function [17], as well as in those with myocardial infarction [18,19], has also been associated with sudden death [20,21]. Our study revealed that there is (36.66%) of patients with chronic renal failure had hypotension episodes during the hemodialysis (table 3).…”

“…In uremia patients, increased plasma and tissue levels of catecholamine and resistance to their physiologic effect were reported by several authors [15,16,17].Clinical and laboratory evidence suggests that both B-adrenoreceptor and muscarinergic receptor -mediated responses are attenuated in the uremia state [18,19]. Furthermore, other endocrine and procaine systems that might affect sympathetic activity such as insulin release or the L-arginine-nitric oxide pathway are also impaired by renal insufficiency [20,21].…”