Acute Hemodynamic Response and Uremic Toxin Removal in Conventional and Extended Hemodialysis and Hemodiafiltration: A Randomized Crossover Study

Cornelis, T.; Sande, Frank M. van der; Eloot, Sunny; Cardinaels, Eline P.M.; Bekers, Otto; Damoiseaux, Jan; Leunissen, Karel M.L.; Kooman, Jeroen P.

doi:10.1053/j.ajkd.2014.02.016

Cited by 90 publications

(77 citation statements)

References 49 publications

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“…In a recent study, we observed a fall in cardiac output of –1.4 ± 1.5 L/min during 4 h of HD with a decline in RBV of 8.1 ± 1.5%. [13]. However, even despite a fall in cardiac output, blood pressure can still be maintained if systemic vascular resistance rises appropriately.…”

Section: Pathophysiology Of Idh: Treatment-related Factorsmentioning

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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Section: Pathophysiology Of Idh: Treatment-related Factorsmentioning

confidence: 99%

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

et al. 2018

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“…In this respect, it is interesting to note that the magnitude of convection volume is considered the dose of HDF, as formulated during a previous EUDIAL consensus meeting [30]. Other effects of HDF that could be related to a superior clinical outcome include a better intra-dialytic hemodynamic stability [31], a reduced inflammatory state and/or an improved nutritional status. Nevertheless, the exclusion of treatment time as an important contributor to the beneficial effect of high-volume HDF is an important step forward in the understanding of this, still controversial, area.…”

Section: Discussionmentioning

confidence: 99%

Treatment Time or Convection Volume in HDF: What Drives the Reduced Mortality Risk?

Zuijdewijn

Nubé²,

Wee³

et al. 2015

Blood Purif

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Background/Aims: Treatment time is associated with survival in hemodialysis (HD) patients and with convection volume in hemodiafiltration (HDF) patients. High-volume HDF is associated with improved survival. Therefore, we investigated whether this survival benefit is explained by treatment time. Methods: Participants were subdivided into four groups: HD and tertiles of convection volume in HDF. Three Cox regression models were fitted to calculate hazard ratios (HRs) for mortality of HDF subgroups versus HD: (1) crude, (2) adjusted for confounders, (3) model 2 plus mean treatment time. As the only difference between the latter models is treatment time, any change in HRs is due to this variable. Results: 114/700 analyzed individuals were treated with high-volume HDF. HRs of high-volume HDF are 0.61, 0.62 and 0.64 in the three models, respectively (p values <0.05). Confidence intervals of models 2 and 3 overlap. Conclusion: The survival benefit of high-volume HDF over HD is independent of treatment time.

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“…In a randomized crossover study, we recently confirmed improvement of hemodynamic and cardiac stability during extended as opposed to conventional HD sessions. 46 The observed hemodynamic stability during longer HD treatments involved not only measurements of peripheral systolic BP but also peripheral diastolic and central BP. Cardiac output also exhibited more stability during extended HD sessions, associated with better preservation of relative blood volume during longer dialysis sessions.…”

Section: Clinical Benefits Of High-dose Hdmentioning

confidence: 99%

Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

Mitsides¹,

Mitra²,

Cornelis

2016

IJNRD

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Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist.

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Acute Hemodynamic Response and Uremic Toxin Removal in Conventional and Extended Hemodialysis and Hemodiafiltration: A Randomized Crossover Study

Cited by 90 publications

References 49 publications

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

Novel Insights into the Pathogenesis and Prevention of Intradialytic Hypotension

Treatment Time or Convection Volume in HDF: What Drives the Reduced Mortality Risk?

Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

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