Changes in extracellular water with hemodialysis and fall in systolic blood pressure
Introduction: Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic...
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| Veröffentlicht in: | International journal of artificial organs 2022-02, Vol.45 (2), p.140-145 |
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| creator | Tangvoraphonkchai, Kamonwan Davenport, Andrew |
| description | Introduction:
Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic blood pressure (SBP).
Methods:
We retrospectively reviewed the records of adult dialysis outpatients attending for their midweek sessions who had corresponding pre- and post-HD bioimpedance measurements of ECW.
Result:
We reviewed 736 patients, median age 67 (54–76) years, 62.8% male, 45.7% diabetic with a median dialysis vintage of 24.4 (9.2–56.8) months. The percentage fall in ECW (ECW%) was associated with post-dialysis systolic blood pressure (SBP) (r = −0.14, p 20 mmHg had a greater fall in ECW% compared to patients with stable SBP 7.6 (4.6–10.1) vs 6.0 (4.0–8.5), p |
| doi_str_mv | 10.1177/0391398821995503 |
| format | Article |
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Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic blood pressure (SBP).
Methods:
We retrospectively reviewed the records of adult dialysis outpatients attending for their midweek sessions who had corresponding pre- and post-HD bioimpedance measurements of ECW.
Result:
We reviewed 736 patients, median age 67 (54–76) years, 62.8% male, 45.7% diabetic with a median dialysis vintage of 24.4 (9.2–56.8) months. The percentage fall in ECW (ECW%) was associated with post-dialysis systolic blood pressure (SBP) (r = −0.14, p < 0.001). Patients with SBP falls of >20 mmHg had a greater fall in ECW% compared to patients with stable SBP 7.6 (4.6–10.1) vs 6.0 (4.0–8.5), p < 0.001). Patients with greater dialyzer urea clearance had greater fall in ECW% (r = 0.19, p < 0.001). In a logistic model an increased fall in ECW% was associated with weight loss (odds ratio (OR) 1.88, 95% confidence limits (CL) 1.62–2.176, p < 0.001), and session duration (OR 1.45 (CL 1.05–1.99), p = 0.024), and negatively with hemodiafiltration compared to hemodialysis (OR 0.37 (0.19–0.74) p = 0.005 and dialysate sodium to plasma gradient (OR 0.95 (CL 0.90–0.99), p = 0.021).
Conclusion:
We observed an association between the reduction in ECW and SBP with dialysis. Our results would advocate monitoring ECW changes during dialysis and developing biofeedback devices to control ultrafiltration and dialysate sodium to reduce the risk of IDH.</description><identifier>ISSN: 0391-3988</identifier><identifier>EISSN: 1724-6040</identifier><identifier>DOI: 10.1177/0391398821995503</identifier><identifier>PMID: 33611962</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Aged ; Biofeedback ; Blood Pressure ; Confidence limits ; Diabetes mellitus ; Dialysate ; Dialysis ; Feedback ; Female ; Hemodialysis ; Humans ; Hypotension ; Hypotension - etiology ; Kidney Failure, Chronic ; Male ; Original s ; Renal Dialysis - adverse effects ; Retrospective Studies ; Risk reduction ; Sodium ; Ultrafiltration ; Urea ; Water ; Weight loss</subject><ispartof>International journal of artificial organs, 2022-02, Vol.45 (2), p.140-145</ispartof><rights>The Author(s) 2021</rights><rights>Copyright Wichtig Editore s.r.l. Feb 2022</rights><rights>The Author(s) 2021 2021 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-fd2f00f829c750f6eb1c556594a239c49f7720cfae584b70be59482b0223ddcd3</citedby><cites>FETCH-LOGICAL-c462t-fd2f00f829c750f6eb1c556594a239c49f7720cfae584b70be59482b0223ddcd3</cites><orcidid>0000-0002-4467-6833</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0391398821995503$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0391398821995503$$EHTML$$P50$$Gsage$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,21818,27923,27924,43620,43621</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33611962$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tangvoraphonkchai, Kamonwan</creatorcontrib><creatorcontrib>Davenport, Andrew</creatorcontrib><title>Changes in extracellular water with hemodialysis and fall in systolic blood pressure</title><title>International journal of artificial organs</title><addtitle>Int J Artif Organs</addtitle><description>Introduction:
Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic blood pressure (SBP).
Methods:
We retrospectively reviewed the records of adult dialysis outpatients attending for their midweek sessions who had corresponding pre- and post-HD bioimpedance measurements of ECW.
Result:
We reviewed 736 patients, median age 67 (54–76) years, 62.8% male, 45.7% diabetic with a median dialysis vintage of 24.4 (9.2–56.8) months. The percentage fall in ECW (ECW%) was associated with post-dialysis systolic blood pressure (SBP) (r = −0.14, p < 0.001). Patients with SBP falls of >20 mmHg had a greater fall in ECW% compared to patients with stable SBP 7.6 (4.6–10.1) vs 6.0 (4.0–8.5), p < 0.001). Patients with greater dialyzer urea clearance had greater fall in ECW% (r = 0.19, p < 0.001). In a logistic model an increased fall in ECW% was associated with weight loss (odds ratio (OR) 1.88, 95% confidence limits (CL) 1.62–2.176, p < 0.001), and session duration (OR 1.45 (CL 1.05–1.99), p = 0.024), and negatively with hemodiafiltration compared to hemodialysis (OR 0.37 (0.19–0.74) p = 0.005 and dialysate sodium to plasma gradient (OR 0.95 (CL 0.90–0.99), p = 0.021).
Conclusion:
We observed an association between the reduction in ECW and SBP with dialysis. Our results would advocate monitoring ECW changes during dialysis and developing biofeedback devices to control ultrafiltration and dialysate sodium to reduce the risk of IDH.</description><subject>Adult</subject><subject>Aged</subject><subject>Biofeedback</subject><subject>Blood Pressure</subject><subject>Confidence limits</subject><subject>Diabetes mellitus</subject><subject>Dialysate</subject><subject>Dialysis</subject><subject>Feedback</subject><subject>Female</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypotension - etiology</subject><subject>Kidney Failure, Chronic</subject><subject>Male</subject><subject>Original s</subject><subject>Renal Dialysis - adverse effects</subject><subject>Retrospective Studies</subject><subject>Risk reduction</subject><subject>Sodium</subject><subject>Ultrafiltration</subject><subject>Urea</subject><subject>Water</subject><subject>Weight loss</subject><issn>0391-3988</issn><issn>1724-6040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>EIF</sourceid><recordid>eNp1kTuP1DAUhS0EYoeFngpFoqEJ2NevuEFCI17SSjRLbTnOzYxXnniwE2D-PY5mWWAlGrs43zm-x5eQ54y-ZkzrN5Qbxk3XATNGSsofkA3TIFpFBX1INqvcrvoFeVLKDaVMCSEfkwvOFWNGwYZcb_du2mFpwtTgzzk7jzEu0eXmh5uxnmHeN3s8pCG4eCqhNG4amtHFuDrKqcwpBt_0MaWhOWYsZcn4lDyqRMFnt_cl-frh_fX2U3v15ePn7bur1gsFczsOMFI6dmC8lnRU2DMvpZJGOODGCzNqDdSPDmUnek17rFIHPQXgw-AHfknennOPS3_AweNUC0R7zOHg8skmF-y_yhT2dpe-204bzhmrAa9uA3L6tmCZ7SGU9QfchGkpFoQB6KRWqqIv76E3aclTrWdBgaJgKlgpeqZ8TqVkHO-GYdSuK7P3V1YtL_4ucWf4vaMKtGeguB3-efW_gb8A266fMw</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Tangvoraphonkchai, Kamonwan</creator><creator>Davenport, Andrew</creator><general>SAGE Publications</general><general>Wichtig Editore s.r.l</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QF</scope><scope>7QO</scope><scope>7QQ</scope><scope>7SC</scope><scope>7SE</scope><scope>7SP</scope><scope>7SR</scope><scope>7TA</scope><scope>7TB</scope><scope>7U5</scope><scope>8BQ</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>H8D</scope><scope>H8G</scope><scope>JG9</scope><scope>JQ2</scope><scope>KR7</scope><scope>L7M</scope><scope>L~C</scope><scope>L~D</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4467-6833</orcidid></search><sort><creationdate>20220201</creationdate><title>Changes in extracellular water with hemodialysis and fall in systolic blood pressure</title><author>Tangvoraphonkchai, Kamonwan ; Davenport, Andrew</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-fd2f00f829c750f6eb1c556594a239c49f7720cfae584b70be59482b0223ddcd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biofeedback</topic><topic>Blood Pressure</topic><topic>Confidence limits</topic><topic>Diabetes mellitus</topic><topic>Dialysate</topic><topic>Dialysis</topic><topic>Feedback</topic><topic>Female</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Hypotension - etiology</topic><topic>Kidney Failure, Chronic</topic><topic>Male</topic><topic>Original s</topic><topic>Renal Dialysis - adverse effects</topic><topic>Retrospective Studies</topic><topic>Risk reduction</topic><topic>Sodium</topic><topic>Ultrafiltration</topic><topic>Urea</topic><topic>Water</topic><topic>Weight loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tangvoraphonkchai, Kamonwan</creatorcontrib><creatorcontrib>Davenport, Andrew</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Aluminium Industry Abstracts</collection><collection>Biotechnology Research Abstracts</collection><collection>Ceramic Abstracts</collection><collection>Computer and Information Systems Abstracts</collection><collection>Corrosion Abstracts</collection><collection>Electronics & Communications Abstracts</collection><collection>Engineered Materials Abstracts</collection><collection>Materials Business File</collection><collection>Mechanical & Transportation Engineering Abstracts</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>METADEX</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology & Engineering</collection><collection>Engineering Research Database</collection><collection>Aerospace Database</collection><collection>Copper Technical Reference Library</collection><collection>Materials Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>Civil Engineering Abstracts</collection><collection>Advanced Technologies Database with Aerospace</collection><collection>Computer and Information Systems Abstracts Academic</collection><collection>Computer and Information Systems Abstracts Professional</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tangvoraphonkchai, Kamonwan</au><au>Davenport, Andrew</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in extracellular water with hemodialysis and fall in systolic blood pressure</atitle><jtitle>International journal of artificial organs</jtitle><addtitle>Int J Artif Organs</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>45</volume><issue>2</issue><spage>140</spage><epage>145</epage><pages>140-145</pages><issn>0391-3988</issn><eissn>1724-6040</eissn><abstract>Introduction:
Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic blood pressure (SBP).
Methods:
We retrospectively reviewed the records of adult dialysis outpatients attending for their midweek sessions who had corresponding pre- and post-HD bioimpedance measurements of ECW.
Result:
We reviewed 736 patients, median age 67 (54–76) years, 62.8% male, 45.7% diabetic with a median dialysis vintage of 24.4 (9.2–56.8) months. The percentage fall in ECW (ECW%) was associated with post-dialysis systolic blood pressure (SBP) (r = −0.14, p < 0.001). Patients with SBP falls of >20 mmHg had a greater fall in ECW% compared to patients with stable SBP 7.6 (4.6–10.1) vs 6.0 (4.0–8.5), p < 0.001). Patients with greater dialyzer urea clearance had greater fall in ECW% (r = 0.19, p < 0.001). In a logistic model an increased fall in ECW% was associated with weight loss (odds ratio (OR) 1.88, 95% confidence limits (CL) 1.62–2.176, p < 0.001), and session duration (OR 1.45 (CL 1.05–1.99), p = 0.024), and negatively with hemodiafiltration compared to hemodialysis (OR 0.37 (0.19–0.74) p = 0.005 and dialysate sodium to plasma gradient (OR 0.95 (CL 0.90–0.99), p = 0.021).
Conclusion:
We observed an association between the reduction in ECW and SBP with dialysis. Our results would advocate monitoring ECW changes during dialysis and developing biofeedback devices to control ultrafiltration and dialysate sodium to reduce the risk of IDH.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>33611962</pmid><doi>10.1177/0391398821995503</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4467-6833</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of artificial organs, 2022-02, Vol.45 (2), p.140-145 |
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| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List |
| subjects | Adult Aged Biofeedback Blood Pressure Confidence limits Diabetes mellitus Dialysate Dialysis Feedback Female Hemodialysis Humans Hypotension Hypotension - etiology Kidney Failure, Chronic Male Original s Renal Dialysis - adverse effects Retrospective Studies Risk reduction Sodium Ultrafiltration Urea Water Weight loss |
| title | Changes in extracellular water with hemodialysis and fall in systolic blood pressure |
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