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Yu J, Chen X, Li Y, Wang Y, Liu Z, Shen B, Teng J, Zou J, Ding X. Paradoxical Association Between Intradialytic Blood Pressure Change and Long-Term Mortality with Different Levels of Interdialytic Weight Gain. Int J Gen Med 2021; 14:211-220. [PMID: 33505169 PMCID: PMC7829598 DOI: 10.2147/ijgm.s288038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background A greater interdialytic weight gain (IDWG) implies a greater ultrafiltration rate, which might lead to hemodynamic instability and intradialytic blood pressure (BP) change in hemodialysis patients. However, current studies have not explicated the impact of IDWG on the association between intradialytic BP changes and prognosis, especially in patients without cardiac dysfunction and diabetes. In this study, we aimed to explore the relationship between absolute intradialytic BP changes and mortality with different IDWG levels. Methods A total of 204 hemodialysis patients (without cardiac dysfunction and diabetes) were included in this prospective observation study, with a mean follow-up of 55.32±20.99 months. Initially, we collected IDWG, IDWG% (percentages according to dry weight), and pre-/post-BPs of 36 consecutive dialysis sessions during three months enrollment. And the average value of them was defined as baseline value. Patients were divided into 3 cohorts according to IDWG% tertiles (<3.3%, 3.3%-4.6%, ≥4.6%). Comparisons between different tertiles were analyzed. Results Compared to the low IDWG% group (tertile 1, T1), patients of high IDWG% group (tertile 3, T3) were younger, had higher ultrafiltration rate, less residual kidney function, lower BMI and dry weight, longer dialysis vintage and higher N terminal pro B type natriuretic peptide levels (P<0.05). Correlations were found between IDWG% and intradialytic BP changes. Kaplan-Meier analysis and multivariate Cox regression model adjusted for demographic data, dialysis information and predialysis BPs indicated that greater absolute intradialytic BP changes were associated with worse prognosis in T1 group (P<0.05). While in T3 group, less absolute intradialytic BP changes were associated with higher mortality (P<0.05). Conclusion There is a paradoxical association between absolute intradialytic BP changes and long-term mortality with different IDWG levels. Both BP stability and volume balance are crucial to patients' prognosis.
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Affiliation(s)
- Jinbo Yu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Yang Li
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Yaqiong Wang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Jie Teng
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
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Hecking M, Karaboyas A, Antlanger M, Saran R, Wizemann V, Chazot C, Rayner H, Hörl WH, Pisoni RL, Robinson BM, Sunder-Plassmann G, Moissl U, Kotanko P, Levin NW, Säemann MD, Kalantar-Zadeh K, Port FK, Wabel P. Significance of interdialytic weight gain versus chronic volume overload: consensus opinion. Am J Nephrol 2013; 38:78-90. [PMID: 23838386 DOI: 10.1159/000353104] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/04/2013] [Indexed: 12/13/2022]
Abstract
Predialysis volume overload is the sum of interdialytic weight gain (IDWG) and residual postdialysis volume overload. It results mostly from failure to achieve an adequate volume status at the end of the dialysis session. Recent developments in bioimpedance spectroscopy and possibly relative plasma volume monitoring permit noninvasive volume status assessment in hemodialysis patients. A large proportion of patients have previously been shown to be chronically volume overloaded predialysis (defined as >15% above 'normal' extracellular fluid volume, equivalent to >2.5 liters on average), and to exhibit a more than twofold increased mortality risk. By contrast, the magnitude of the mortality risk associated with IDWG is much smaller and only evident with very large weight gains. Here we review the available evidence on volume overload and IDWG, and question the use of IDWG as an indicator of 'nonadherence' by describing its association with postdialysis volume depletion. We also demonstrate the relationship between IDWG, volume overload and predialysis serum sodium concentration, and comment on salt intake. Discriminating between volume overload and IDWG will likely lead to a more appropriate management of fluid withdrawal during dialysis. Consensually, the present authors agree that this discrimination should be among the primary goals for dialysis caretakers today. In consequence, we recommend objective measures of volume status beyond mere evaluations of IDWG.
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Affiliation(s)
- Manfred Hecking
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
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Liauw SS, McIntyre RS. Atypical antipsychotic tolerability and switching strategies in bipolar disorder. Expert Opin Pharmacother 2010; 11:2827-37. [PMID: 20726821 DOI: 10.1517/14656566.2010.510835] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE TO THE FIELD Atypical antipsychotics have unequivocally advanced the pharmacotherapy of bipolar disorders. These broad-spectrum treatments offer efficacy against core symptoms of acute mania, mixed state, depressed and maintenance phases of the disorder. Atypical antipsychotics are not, however, a panacea and are associated with several problematic tolerability and safety concerns. For example, emerging evidence militates against the original notion that atypical agents are without risk for extrapyramidal side effects and possibly tardive dyskinesia when compared to their therapeutic predecessors, the conventional antipsychotics. Although classified together, atypical antipsychotics are heterogeneous in their tolerability and safety profile, an issue relevant to individualizing treatment selection and switching antipsychotics for optimal clinical management. AREAS COVERED IN THIS REVIEW This article reviews relevant adverse events attributable to the use of atypical antipsychotics and strategies for switching these agents, with particular attention to the bipolar disorder population. WHAT THE READER WILL GAIN The reader will gain both a perspective of treatment-emergent adverse events associated with atypical agents in the treatment of bipolar disorder and a precise analysis of common adverse events that frequently lead to treatment discontinuation and/or switching to a separate agent. TAKE HOME MESSAGE Atypical antipsychotics provide for a different array of treatment-emergent adverse events than conventional agents. The therapeutic index of treatment is a ratio of the relative benefit divided by the probability of harm (i.e., side effects). Taken together, the atypical antipsychotics offer an improved therapeutic index when compared to conventional agents in bipolar disorder. Nevertheless, atypicals fall short of the ideal, necessitating frequent discontinuation and switching.
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Denhaerynck K, Manhaeve D, Dobbels F, Garzoni D, Nolte C, De Geest S. Prevalence and Consequences of Nonadherence to Hemodialysis Regimens. Am J Crit Care 2007. [DOI: 10.4037/ajcc2007.16.3.222] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Adherence to fluid restrictions and dietary and medication guidelines as well as attendance at prescribed hemodialysis sessions of a hemodialysis regimen are essential for adequate management of end-stage renal disease. A literature review was conducted to determine the prevalence and consequences of nonadherence to the different aspects of a hemodialysis regimen and the methodological obstacles in research on nonadherence. Nonadherence to the prescribed regimen is a common problem in hemodialysis and is associated with increased morbidity and mortality. Research on nonadherence is associated with 2 major obstacles: inconsistencies in definitions and invalid measurement methods. Further research is needed to validate measurement methods and to establish clinically relevant operational definitions of nonadherence.
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Affiliation(s)
- Kris Denhaerynck
- Kris Denhaerynck is a postdoctoral fellow and Sabina De Geest is a professor of nursing with the Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Dominique Manhaeve
- Dominique Manhaeve is a clinical trial leader with Tibotec BVBA, Mechelen, Belgium
| | - Fabienne Dobbels
- Fabienne Dobbels is a postdoctoral fellow at the Center for Health Services and Nursing Research, School of Public Health, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Daniela Garzoni
- Daniela Garzoni and Christa Nolte are an attending physician and a study nurse from the Department of Transplant Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Christa Nolte
- Daniela Garzoni and Christa Nolte are an attending physician and a study nurse from the Department of Transplant Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Sabina De Geest
- Kris Denhaerynck is a postdoctoral fellow and Sabina De Geest is a professor of nursing with the Institute of Nursing Science, University of Basel, Basel, Switzerland
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