The Effect of Frequent and Occasional Dialysis‐Associated Hypotension on Survival of Patients on Hemodialysis

Abstract

Atherosclerotic lesion of coronary artery frequently accompanies intimal hyperplasia of radial artery. We have reported that the lesion of radial artery (intimal hyperplasia) in hemodialysis (HD) patients is associated with early access failure (EAF) as well as ischemic heart disease (IHD) (Am J Kidney Dis. 2003; 41: 422-428). Objective: This study was designed to determine the impact of IHD on the EAF in nondiabetic HD patients. Methods: This study enrolled 125 nondiabetic HD patients who received radiocephalic arteriovenous fistula operation for the first time. We evaluated IHD before the operation through clinical symptoms and electrocardiography and then investigated EAF within 1 year after the operation. We analyzed the access patency rates between the patients with and without IHD, using Kaplan-Meier method and log-rank test. Multiple regression analysis was performed to identify independent risk factors of the EAF. Results: The mean age of the patients was 48 AE 14 years, and the number of females was 54 (43.2%). Of the total 125 patients, 19 patients (15.4%) had IHD before the operation. The EAF developed in 23 patients (18.4%) within 1 years after the operation. The access patency rate in the patients with IHD was lower than that in the patients without IHD (39.7 vs. 88.3%, p < 0.001). IHD and old age were independent risk factors of the EAF in nondiabetic HD patients. But sex, smoking history, hypertension, and the levels of hemoglobin, serum creatinine, albumin, and total cholesterol checked before the operation were not associated with the EAF. Conclusion: This study suggests that IHD is closely associated with EAF in nondiabetic HD patients. Dialysis Staff Time and SupplyCost for the LifeSite System vs. Hemodialysis Catheters D. Shore, S. Vega. West Palm Dialysis --Preferred Medical Group, West Palm Beach, FL, U.S.A.The LifeSite System is a new subcutaneous vascular access option for hemodialysis patients. As the procedure for accessing the Life-Site differs from hemodialysis catheters, we prospectively studied the differences in time required to initiate and discontinue treatments for LifeSite patients compared to patients with hemodialysis catheters. We also collected data on the cost of supplies and the number of alarms during dialysis for both groups. 5 LifeSite and 5 catheter patients were chosen at random for participation in the study. The time required for the ON and OFF procedures was recorded for 3 consecutive dialysis sessions for each patient for a total of 15 observations/group. The average staff time required per session for supply preparation, ON/OFF procedure, dressing changes, and responding to alarms was 15.9 min for the LifeSite and 16.9 min for catheters. Catheter patients experienced 4.5Background: Hemodialysis is often complicated by cardiovascular instability (CVI). We studied factors contributing to

Dialysis-induced hypotension is associated with impaired aortic elasticity in patients undergoing chronic hemodialysis

“…Earlier studies have demonstrated that survival of patients undergoing hemodialysis with DIH was significantly lower compared with those without DIH [2,3]. In agreement to these studies, we found that patients with DIH had higher mortality rates compared with those without DIH.…”

“…It was associated with a significantly increased risk for mortality in patients undergoing hemodialysis [2,3]. DIH is the clinical manifestation of an imbalance between the decreased plasma volume during dialysis and the counter-regulatory cardiovascular haemodynamic and neurohormonal mechanisms [4,5].…”

Special situations: Intradialytic hypertension/chronic hypertension and intradialytic hypotension

“…first demonstrated that among a cohort of dialysis patients followed for 2 years, those that died during follow up had significantly lower nadir systolic BP than the survivors during a single initial treatment at the beginning of the study . In another cohort study, frequent episodes of intradialytic hypotension (more than 10 episodes over 10 months) were associated with significantly increased mortality risk compared to no intradialytic hypotension in unadjusted analyses; but, this failed to achieve statistical significance in fully adjusted models . The aforementioned study by Park et al.…”

Colloids in Dialytic Refractory Hypotension

“…There are two main clinical patterns of dialysis-associated hypotension : the first is episodic hypotension (defined by a sudden drop of systolic blood pressure below 100 mmHg or at least 30 mmHg with accompanying clinical symptoms), that typically occurs during the later stages of dialysis sessions and is generally favored by excessive weight gain ; the second is chronic persistent hypotension, which affects about 10% of long-term dialysis patients [1,2], most of whom experience frequent episodes of hypotension during dialysis sessions, whereas some patients have permanent hypotension with low predialysis systolic pressure, often less than 100 mmHg [3,4]. Intradialytic hypotension not only causes discomfort and has a negative impact on health-related quality of life but it may also adversely affect the outcome of chronic hemodialysis, reducing patients' life expectancy and favoring underdialysis [5][6][7][8][9][10]. According to recent data, low pre-dialytic systolic and diastolic pressures, like low post-dialytic systolic pressure and the occurrence of hypotensive episodes during dialysis sessions, are associated with a significantly increased risk of death [5][6][7][8][9].…”