Hemodynamic effects of intradialytic food ingestion and the effects of caffeine

Although the hypotensive effects of food ingestion during hemodialysis have been documented, the hemodynamic mechanism is unclear. It could be decreased cardiac output due to splanchnic sequestration or decreased vascular resistance due to splanchnic vasorelaxation. Also, the effects of caffeine, which block postprandial hypotension in the elderly, have not been studied in a dialysis setting. Central hemodynamics were monitored by thoracic electric bioimpedance in 10 dialysis patients who ingested a test meal 1 h into dialysis. All ultrafiltration was done during the initial 2 h. Bicarbonate dialysate was used. Each patient was studied three times in a double-blind (with respect to placebo/caffeine) cross-over trial: placebo/no meal, placebo/meal, and caffeine/meal. Blood pressure decreased sooner and to a great extent in the treatments in which food ingestion accompanied ultrafiltration (e.g., at 30 min after food ingestion, percent change in mean arterial pressure was -12.4 +/- 1.8 versus -2.4 +/- 3.5 mm Hg when food was not ingested; P < 0.05). The hemodynamic mechanism of food-associated hypotension was found to be a fall in systemic vascular resistance (SVRI). Caffeine pretreatment (200 mg), which resulted in intradialytic plasma caffeine levels of about 4 micrograms/mL at time of food ingestion, had no effect on food-associated reductions in blood pressure or SVRI. The results suggest that food ingestion during dialysis causes hypotension primarily because of decreased SVRI. The effects of food ingestion on mean arterial pressure and SVRI are not attenuated by the ingestion of 200 mg of caffeine 1 h before dialysis.