Frequency of intradialytic hypotensive episodes: old problem, new insights

Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, Eva

doi:10.1016/j.jash.2015.07.007

Cited by 28 publications

(20 citation statements)

References 24 publications

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“…Major risk factors associated with IDH across studies were diabetes, a higher IDWG, female gender, and lower body weight. Interestingly, the studies within the EBPG definition showed a rather uniform pattern with a prevalence of IDH below 12% with only one exception: Rocha et al [22] reported that as much as 30.7% of HD sessions were complicated by IDH. These authors included multiple episodes of IDH during a single HD session, whereas in most studies, HD sessions with IDH were considered as one event.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Higher IDWG is also a well-known risk factor for the occurrence of IDH [48][49][50]. Rocha et al [22] found a significant association between lower dry weight and recurrent IDH episodes. A higher refill rate from the interstitial tissues in a more fluid overloaded state can be seen as the cause of the higher BP during the first HD session of the week [51].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Of the studies that used the EBPG or a similar definition to identify IDH, there were 5 studies that measured the prevalence of IDH on session level. The prevalence of IDH in these studies ranged between 5.0% in a study with 54 patients and a total of 10,494 HD sessions during an observation period of 18 months [23] and 30.7% in a study with 43 patients with 18 HD sessions per patient over a 1.5-month period [22] (online suppl. File 3).…”

Section: Prevalence Of Idh On Session Levelmentioning

confidence: 99%

“…The most commonly reported patient-related factors were the presence of diabetes [9,18,22,23,28,29,35,36] and a higher IDWG [19,20,25,29,33,35,36]. Both factors together were mentioned in 3 studies [29,35,36].…”

Section: Patient and Treatment Factors Associated With Idhmentioning

confidence: 99%

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The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis

et al. 2019

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Background: Intradialytic hypotension (IDH) is considered to be a frequent complication of hemodialysis (HD) and is associated with symptom burden, increased incidence of access failure, cardiovascular events, and higher mortality. This systematic literature review aims to analyse studies that investigated the prevalence of IDH. A complicating factor herein is that many different definitions of IDH are used in literature. Methods: A systematic literature search from databases, Medline, Cinahl, EMBASE, and the Cochrane library to identify studies reporting on the actual prevalence of IDH was conducted. Studies were categorized by the type of definition used for the prevalence of IDH. A meta-analysis of the prevalence of IDH was performed. Results: In a meta-analysis comprising 4 studies including 1,694 patients and 4 studies including 13,189 patients, the prevalence of HD sessions complicated by IDH was 10.1 and 11.6% for the European Best Practice Guideline (EBPG) definition and the Nadir <90 definition, respectively. The proportion of patients with frequent IDH could not reliably be established because of the wide range in cutoff values that were used to identify patients with frequent IDH. There was a large variety in the prevalence of symptoms and interventions. Major risk factors associated with IDH across studies were diabetes, a higher interdialytic weight gain, female gender, and lower body weight. Conclusion: Our meta-analysis suggests that the prevalence of IDH is lower than 12% for both the EBPG and the Nadir <90 definition which is much lower than stated in most reviews.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Discussion/conclusionmentioning

confidence: 99%

Section: Prevalence Of Idh On Session Levelmentioning

confidence: 99%

Section: Patient and Treatment Factors Associated With Idhmentioning

confidence: 99%

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The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis

et al. 2019

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“…Modifiable risk factors that may reduce intradialytic hypertension episodes include a low dry weight and hypertension. 41 …”

Section: Physical Disabilitymentioning

confidence: 99%

Neurological complications in chronic kidney disease

Arnold

Issar

Krishnan

et al. 2016

JRSM Cardiovascular Disease

171

129

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Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.

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Long‐term impacts of hemodialysis on the right ventricle: Assessment via 3‐dimensional speckle‐tracking echocardiography

Sun

Cao

Guo

et al. 2018

Clinical Cardiology

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Background Right ventricular (RV) dysfunction is a major cause of death in patients undergoing maintenance hemodialysis (MHD). We used 3‐dimensional speckle‐tracking echocardiography (3DSTE) to evaluate long‐term impacts of MHD on RV function. Hypothesis In this study, RV dysfunction in MHD patients will be revealed and studied in depth by 3DSTE. Methods Echocardiography was performed on 110 consecutively enrolled individuals: 30 controls and 80 patients with MHD. Conventional echocardiographic parameters and 3DSTE parameters were obtained and compared between groups. Univariate and multivariate logistic regression analysis identified independent predictors of intradialytic hypotension (IDH). Results Compared with the control group, RV end‐diastolic volume (RVEDV) was markedly enlarged (46.1 ± 11.8 mL/m2 vs 42.3 ± 8.6 mL/m2; P = 0.047), whereas RV ejection fraction (RVEF) was significantly lower in the MHD group (50.6% ± 5.8% vs 55.2% ± 3.7%; P < 0.001). RV global, septal, and lateral wall longitudinal strains were also decreased in the MHD group (−18.2 ± 3.6 vs −22.6 ± 4.3%; −13.1 ± 3.8 vs −17.5 ± 5.5%; and −23.4 ± 4.7 vs −27.7 ± 4.0%, respectively; all P < 0.001). RVEF (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.51 to 1.01, P = 0.038) and history of diabetes (OR: 11.14, 95% CI: 1.16 to 106.71, P = 0.036) were 2 independent predictors of IDH. Ultrafiltration rate was an independent factor associated with RVEF (β = −0.01, 95% CI: −0.019 to 0.001, P = 0.039). Conclusions RVEF by 3DSTE could be an important predictor of IDH in MHD patients, and lower ultrafiltration rate was protective for RVEF. 3DSTE may have potential in RV evaluation and risk stratification in MHD patients.

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Frequency of intradialytic hypotensive episodes: old problem, new insights

Cited by 28 publications

References 24 publications

The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis

The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis

Neurological complications in chronic kidney disease

Long‐term impacts of hemodialysis on the right ventricle: Assessment via 3‐dimensional speckle‐tracking echocardiography

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