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Cho H, Kwon SK, Lee SW, Yang YM, Kim HY, Kim SM, Heo TY, Seong CH, Kim KR. The Association Among Post-hemodialysis Blood Pressure, Nocturnal Hypertension, and Cardiovascular Risk Factors. Electrolyte Blood Press 2023; 21:53-60. [PMID: 38152598 PMCID: PMC10751209 DOI: 10.5049/ebp.2023.21.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
Background Most hemodialysis (HD) patients suffer from hypertension and have a heightened cardiovascular risk. While blood pressure (BP) control is essential to end-stage kidney disease (ESKD) patients, overly stringent control can lead to intradialytic hypotension (IDH). This study aimed to examine BP variations during and after HD to determine whether these variations correlate with IDH risk. Methods BP measurements during dialysis were taken from 28 ESKD patients, and ambulatory BP monitoring was applied post-dialysis. Laboratory parameters and risk factors, including diabetes, coronary disease, and LV mass index, were compared between IDH and non-IDH groups using an independent t-test. Results Of the 28 patients with an average age of 57.4 years, 16 (57.1%) had diabetes, 5 (17.9%) had coronary artery disease, and 1 (3.6%) had cerebrovascular disease. The mean systolic blood pressure (SBP) during and post-HD was 142.26 mmHg and 156.05 mmHg, respectively (p=0.0003). Similarly, the mean diastolic blood pressure (DBP) also demonstrated a significant increase, from 74.59 mmHg during HD to 86.82 mmHg post-HD (p<0.0001). Patients with IDH exhibited a more substantial SBP difference (delta SBP, 36.38 vs. 15.07 mmHg, p=0.0033; age-adjusted OR=1.58, p=0.0168) and a lower post-dialysis BUN level (12.75 vs. 18.77 mg/dL, p=0.0015; age-adjusted OR=0.76, p=0.0242). No significant variations were observed in daytime and nocturnal BP between the IDH and non-IDH groups. Conclusion Hemodialysis patients exhibited a marked increase in post-dialysis BP and lacked a nocturnal BP dip, suggesting augmented cardiovascular risks. This highlights the importance of more stringent BP control after hemodialysis.
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Affiliation(s)
- Hyunjeong Cho
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Soon Kil Kwon
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seung Woo Lee
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yu Mi Yang
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hye Young Kim
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sun Moon Kim
- Renal Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Tae-Young Heo
- Department of Information and Statistics, Chungbuk National University Graduate School, Cheongju, Republic of Korea
| | - Chang Hwan Seong
- Department of Information and Statistics, Chungbuk National University Graduate School, Cheongju, Republic of Korea
| | - Kyeong Rok Kim
- Department of Information and Statistics, Chungbuk National University Graduate School, Cheongju, Republic of Korea
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Yun D, Yang HL, Kim SG, Kim K, Kim DK, Oh KH, Joo KW, Kim YS, Han SS. Real-time dual prediction of intradialytic hypotension and hypertension using an explainable deep learning model. Sci Rep 2023; 13:18054. [PMID: 37872390 PMCID: PMC10593747 DOI: 10.1038/s41598-023-45282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
Both intradialytic hypotension (IDH) and hypertension (IDHTN) are associated with poor outcomes in hemodialysis patients, but a model predicting dual outcomes in real-time has never been developed. Herein, we developed an explainable deep learning model with a sequence-to-sequence-based attention network to predict both of these events simultaneously. We retrieved 302,774 hemodialysis sessions from the electronic health records of 11,110 patients, and these sessions were split into training (70%), validation (10%), and test (20%) datasets through patient randomization. The outcomes were defined when nadir systolic blood pressure (BP) < 90 mmHg (termed IDH-1), a decrease in systolic BP ≥ 20 mmHg and/or a decrease in mean arterial pressure ≥ 10 mmHg (termed IDH-2), or an increase in systolic BP ≥ 10 mmHg (i.e., IDHTN) occurred within 1 h. We developed a temporal fusion transformer (TFT)-based model and compared its performance in the test dataset, including receiver operating characteristic curve (AUROC) and area under the precision-recall curves (AUPRC), with those of other machine learning models, such as recurrent neural network, light gradient boosting machine, random forest, and logistic regression. Among all models, the TFT-based model achieved the highest AUROCs of 0.953 (0.952-0.954), 0.892 (0.891-0.893), and 0.889 (0.888-0.890) in predicting IDH-1, IDH-2, and IDHTN, respectively. The AUPRCs in the TFT-based model for these outcomes were higher than the other models. The factors that contributed the most to the prediction were age and previous session, which were time-invariant variables, as well as systolic BP and elapsed time, which were time-varying variables. The present TFT-based model predicts both IDH and IDHTN in real time and offers explainable variable importance.
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Affiliation(s)
- Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Lim Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seong Geun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Shimamoto Y, Sasaki H, Kasuno K, Watanabe Y, Sakashita S, Nishikawa S, Nishimori K, Morita S, Nishikawa Y, Kobayashi M, Fukushima S, Enomoto S, Takahashi N, Hamano T, Sakamaki I, Iwasaki H, Iwano M. Posterior reversible encephalopathy syndrome (PRES) associated with SARS-CoV-2 infection in a patient under maintenance haemodialysis: a case report. BMC Nephrol 2023; 24:286. [PMID: 37773103 PMCID: PMC10542676 DOI: 10.1186/s12882-023-03319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Endothelial dysfunction is common in patients undergoing chronic haemodialysis, and is a major cause of posterior reversible encephalopathy syndrome (PRES). Recently, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to cause endothelial dysfunction by infecting vascular endothelial cells. Several cases of neurological complications in patients without kidney dysfunction, and only a few cases in patients with chronic kidney disease, have been reported in the literature. However, no previous report has yet described PRES associated with SARS-CoV-2 infection among patients undergoing maintenance dialysis. CASE PRESENTATION A 54-year-old woman undergoing maintenance haemodialysis was admitted to our hospital for status epilepticus. She had developed end-stage kidney disease (ESKD) secondary to diabetic nephropathy. Seven days prior to admission, she had developed fever and was diagnosed with COVID-19. Subsequently her blood pressure increased from 160/90 mmHg to 190/100 mmHg. On admission, she presented with severe hypertension (> 220/150 mmHg), unconsciousness, and epilepticus. CT tomography revealed no signs of brain haemorrhage. Cranio-spinal fluid (CSF) examination revealed no signs of encephalitis, and CSF polymerase chain reaction (PCR) for SARS-CoV-2 was negative. MRI findings revealed focal T2/FLAIR hyperintensity in the bilateral parietooccipital regions, leading to the diagnosis of PRES. Deep sedation and strict blood pressure control resulted in a rapid improvement of her symptoms, and she was discharged without sequelae. CONCLUSIONS We report the first case of PRES associated with SARS-CoV-2 infection in a patient undergoing maintenance haemodialysis. Patients undergoing maintenance haemodialysis are at high risk of PRES because of several risk factors. SARS-CoV-2 infection causes direct invasion of endothelial cells by binding to angiotensin-converting enzyme 2 (ACE2), initiating cytokine release, and hypercoagulation, leading to vascular endothelial cell injury and increased vascular leakage. In the present case, SARS-CoV-2 infection possibly be associated with the development of PRES.
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Affiliation(s)
- Yuki Shimamoto
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Hirohito Sasaki
- Division of Neurology, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenji Kasuno
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan.
| | - Yuki Watanabe
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sayumi Sakashita
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sho Nishikawa
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Kazuhisa Nishimori
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sayu Morita
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Yudai Nishikawa
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Mamiko Kobayashi
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Sachiko Fukushima
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Soichi Enomoto
- Division of Neurology, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Naoki Takahashi
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
| | - Tadanori Hamano
- Division of Neurology, Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ippei Sakamaki
- Department of Infectious Diseases, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Masayuki Iwano
- Department of Nephrology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki Eiheiji-cho Yoshida-gun, Fukui, Japan
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Nakamura H, Hiu T, Yamamoto Y, Oda S, Izumo T, Matsuo T. Current status of stroke in hemodialysis patients on a remote island. PLoS One 2023; 18:e0288731. [PMID: 37682834 PMCID: PMC10490869 DOI: 10.1371/journal.pone.0288731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES Hemodialysis patients have a higher incidence of stroke than healthy individuals. Hemodialysis patients living on remote islands are subject to additional distance and transportation difficulties. Therefore, we aimed to study the association between stroke and hemodialysis in patients living on remote islands. MATERIALS AND METHODS We conducted a retrospective cohort study based on the medical records of maintenance hemodialysis patients in Shinkamigoto-Cho, Nagasaki, Japan, between June 1, 2005, and June 31, 2022. The clinical characteristics, probability of hemorrhagic stroke, acute ischemic stroke-free rate, and survival probability with or without a history of anticoagulant/antiplatelet use were evaluated. The survival probability among the hemorrhagic stroke, acute ischemic stroke, and non-stroke groups was also evaluated. RESULTS This study involved 142 patients. Nine patients (6.3%) had intracerebral hemorrhage, one (0.7%) had subarachnoid hemorrhage, eight (5.6%) had acute ischemic stroke, and 124 (87.3%) had no stroke. The number of patients with severe disabilities (modified Rankin Scale 5/6) was significantly higher in the hemorrhagic stroke group. The probability of hemorrhagic stroke and acute ischemic stroke-free rate, or survival probability with or without a history of anticoagulant/antiplatelet use, were not significantly different. The acute ischemic stroke group was not associated with a lower survival probability than the other groups. The hemorrhagic stroke group had a significantly lower survival probability than the acute ischemic stroke group. CONCLUSIONS This is the first study to report the status of stroke in hemodialysis patients living on remote islands, thus providing valuable information for improved stroke management in such patients.
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Affiliation(s)
- Hikaru Nakamura
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Internal Medicine, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhito Yamamoto
- Department of Internal Medicine, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Shinya Oda
- Department of Internal Medicine, Nagasaki Kamigoto Hospital, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Tseng YH, Wong MY, Kao CC, Lin CC, Lu MS, Lu CH, Huang YK. The role of venous pressure variability during hemodialysis in the prediction of impending arteriovenous graft occlusion. J Vasc Access 2023; 24:895-903. [PMID: 34772292 DOI: 10.1177/11297298211057381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Elevated venous pressure during hemodialysis (VPHD) is associated with arteriovenous graft (AVG) stenosis. This study investigated the role of VPHD variations in the prediction of impending AVG occlusion. METHODS Data were retrieved from 118 operations to treat AVG occlusion (occlusion group) and 149 operations to treat significant AVG stenosis (stenosis group). In addition to analyzing the VPHD values for the three hemodialysis (HD) sessions prior to the intervention, VPHD values were normalized to mean blood pressure (MBP), blood flow rate (BFR), BFR × MBP, and BFR2 × MBP to yield ratios for analysis. The coefficient of variation (CV) was used to measure relative variations. RESULTS The within-group comparisons for both groups revealed no significant differences in the VPHD mean and CV values among the three HD sessions prior to intervention. However, the CVs for VPHD/MBP, VPHD/(BFR × MBP), and VPHD/(BFR2 × MBP) exhibited significant elevation in the occlusion group during the last HD session prior to intervention compared with both the penultimate and antepenultimate within-group HD data (p < 0.05). In the receiver operating characteristic curve analysis, the CV for VPHD/(BFR2 × MBP) was the only parameter able to discriminate between the last and the penultimate HD outcomes (p < 0.001). According to a multivariate analysis, after controlling for covariates, CV for VPHD/(BFR2 × MBP) >8.76% was associated with a higher risk of AVG thrombosis (odds ratio: 3.17, p < 0.001). CONCLUSIONS Increasing the variation in VPHD/(BFR2 × MBP) may increase the probability of AVG occlusion.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
- Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi City
- Institute of Imaging and Biomedical Photonics, College of Photonics, National Chiao Tung University, Tainan
| | - Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Chao Lin
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Ming-Shian Lu
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Chu-Hsueh Lu
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
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Liu Q, Wang W, Wu X, Lv J, Cai S, Li Y. Intra-dialytic blood pressure variability is a greater predictor of cardiovascular events in hemodialysis patients. BMC Nephrol 2023; 24:113. [PMID: 37101121 PMCID: PMC10134565 DOI: 10.1186/s12882-023-03162-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Short-term and long-term blood pressure variability (BPV) in hemodialysis (HD) population are risk factors of cardiovascular diseases (CVD) and all-cause mortality. There is no full consensus on the best BPV metric. We compared the prognostic role of intra-dialytic and visit-to-visit BPV metrics for CVD morbidity and all-cause mortality in HD patients. METHODS A retrospective cohort of 120 patients on HD was followed up for 44 months. Systolic blood pressure (SBP) and baseline characteristics were collected for 3 months. We calculated intra-dialytic and visit-to-visit BPV metrics, including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), average real variability (ARV) and residual. The primary outcomes were CVD events and all-cause mortality. RESULTS In Cox regression analysis, both intra-dialytic and visit-to-visit BPV metrics were associated with increased CVD events (intra-dialytic CV: HR 1.70, 95% CI 1.28-2.27, p < 0.01; visit-to-visit CV: HR 1.55, 95% CI 1.12-2.16, p < 0.01), but not associated with increased all-cause mortality (intra-dialytic CV: HR 1.32, 95% CI 0.99-1.76, p = 0.06; visit-to-visit CV: HR 1.22, 95% CI 0.91-1.63, p = 0.18). Overall, intra-dialytic BPV showed greater prognostic ability than visit-to-visit BPV for both CVD event (AUC of intra-dialytic BPV and visit-to-visit BPV metrics respectively: SD 0.686, 0.606; CV 0.672, 0.425; VIM 0.677, 0.581; ARV 0.684, 0.618; residual 0.652, 0.586) and all-cause mortality (SD 0.671, 0.608; CV 0.662, 0.575; VIM 0.669, 0.581; ARV 0.529, 0.588; residual 0.651, 0.602). CONCLUSION Compared to visit-to-visit BPV, intra-dialytic BPV is a greater predictor of CVD event in HD patients. No obvious priority was found among various BPV metrics.
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Affiliation(s)
- Qixing Liu
- School of Medicine, Tsinghua University, Beijing, China
| | - Wei Wang
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xianglan Wu
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jiaxuan Lv
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Shiming Cai
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuehong Li
- Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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Avci M, Arikan F. The effect of food intake during hemodialysis on blood pressure: A nonrandomized experimental trial. Ther Apher Dial 2023. [PMID: 36606660 DOI: 10.1111/1744-9987.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intradialytic hypotension (IDH) is one of the most important intradialytic complications and is thought to be associated with intradialytic food intake. Allowing intradialytic feeding is still unclear. This study aimed to determine the relationship between IDH and intradialytic food intake. METHODS A nonrandomized experimental study was conducted to determine the effect of intradialytic food intake on blood pressure (BP) in hemodialysis patients. Each patient was assessed twice using an ambulatory BP monitor with and without intradialytic food intake. RESULTS The study was completed with 54 patients. Intradialytic hypotension developed in 40 patients (74.1%) during the food intake session, while intradialytic hypotension developed in 22 participants (40%) in the no-food session. Repeated BP readings showed that eating 2 h or more after the start of hemodialysis significantly reduced BP. CONCLUSIONS Intradialytic food intake affects the development of IDH. Patients who ate during hemodialysis had a trend of higher of IDH than those who ate nothing during hemodialysis. Eating during dialysis is not recommended.
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Affiliation(s)
- Melek Avci
- Health Services Vocational School, Akdeniz University, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Canaud B, Kooman J, Maierhofer A, Raimann J, Titze J, Kotanko P. Sodium First Approach, to Reset Our Mind for Improving Management of Sodium, Water, Volume and Pressure in Hemodialysis Patients, and to Reduce Cardiovascular Burden and Improve Outcomes. FRONTIERS IN NEPHROLOGY 2022; 2:935388. [PMID: 37675006 PMCID: PMC10479686 DOI: 10.3389/fneph.2022.935388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 09/08/2023]
Abstract
New physiologic findings related to sodium homeostasis and pathophysiologic associations require a new vision for sodium, fluid and blood pressure management in dialysis-dependent chronic kidney disease patients. The traditional dry weight probing approach that has prevailed for many years must be reviewed in light of these findings and enriched by availability of new tools for monitoring and handling sodium and water imbalances. A comprehensive and integrated approach is needed to improve further cardiac health in hemodialysis (HD) patients. Adequate management of sodium, water, volume and hemodynamic control of HD patients relies on a stepwise approach: the first entails assessment and monitoring of fluid status and relies on clinical judgement supported by specific tools that are online embedded in the HD machine or devices used offline; the second consists of acting on correcting fluid imbalance mainly through dialysis prescription (treatment time, active tools embedded on HD machine) but also on guidance related to diet and thirst management; the third consist of fine tuning treatment prescription to patient responses and tolerance with the support of innovative tools such as artificial intelligence and remote pervasive health trackers. It is time to come back to sodium and water imbalance as the root cause of the problem and not to act primarily on their consequences (fluid overload, hypertension) or organ damage (heart; atherosclerosis, brain). We know the problem and have the tools to assess and manage in a more precise way sodium and fluid in HD patients. We strongly call for a sodium first approach to reduce disease burden and improve cardiac health in dialysis-dependent chronic kidney disease patients.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, Montpellier, France
- Global Medical Office, Freseenius Medical Care (FMC)-France, Fresnes, France
| | - Jeroen Kooman
- Maastricht University Maastricht Medical Center (UMC), Maastricht University, Maastricht, Netherlands
| | - Andreas Maierhofer
- Global Research Development, Fresenius Medical Care (FMC) Deutschland GmbH, Bad Homburg, Germany
| | - Jochen Raimann
- Research Division, Renal Research Institute, New York, NY, United States
| | - Jens Titze
- Cardiovascular and Metabolic Disease Programme, Duke-National University Singapore (NUS) Medical School, Singapore, Singapore
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, United States
- Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8160269. [PMID: 35783584 PMCID: PMC9246598 DOI: 10.1155/2022/8160269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 01/26/2023]
Abstract
Acute kidney failure patients while detoxificated by hemodialysis (HD) mostly or continuously faced regular problems such as low blood pressure (hypotension), muscle cramps, nausea, or vomiting. Higher intradialytic symptom leads to low-quality HD treatment. Although more known therapeutic interventions are used to relieve the HD side effects, this study was designed to investigate how intelligent systems can make highly beneficial alterations in dialysis facilities and equipment to ease intradialytic complications and help the staff deliver high-quality treatment. A search was performed among relevant research articles based on nonpharmacological intervention methods considered to prevent adverse effects of renal replacement therapy until 2020 in the PubMed databases using the terms “intradialytic complications,” “intradialytic complication interventions,” “nonpharmacological interventions,” “intradialytic exercises,” and “adequacy calculation methods.” Studies included the prevalence of intradialytic complications, different strategies with the aim of preventing complications, the outcome of intradialytic exercises on dialysis symptoms, and dialysis dose calculation methods. The results showed the incidence of hypotension varying between 5% and 30%, fatigue, muscular cramps, and vomiting as the most common complications during dialysis, which greatly affect the outcome of HD sessions. To prevent hypotension, ultrafiltration profiling, sodium modeling, low dialysate temperature, and changing the position to Trendelenburg are some strategies. Urea reduction ratio (URR), formal urea kinetic modeling (FUKM), formal single-pool urea kinetics, and online clearance monitoring (OCM) are methods for calculating the delivered dose of dialysis in which OCM is a low-cost and accessible way to monitor regularly the quality of dialysis delivered. Integration of the chair and HD machine which is in direct contact with the patient provides an intelligent system that improves the management of the dialysis session to enhance the quality of healthcare service.
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10
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Russo DS, Eugenio CS, Balestrin IG, Rodrigues CG, Rosa RG, Teixeira C, Kelly YP, Vieira SRR. Comparison of hemodynamic instability among continuous, intermittent and hybrid renal replacement therapy in acute kidney injury: A systematic review of randomized clinical trials. J Crit Care 2022; 69:153998. [PMID: 35124346 DOI: 10.1016/j.jcrc.2022.153998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare hemodynamic instability during continuous, intermittent and hybrid renal replacement therapy (RRT) in critically ill patients, and its association with renal recovery and mortality. MATERIALS AND METHODS The search was conducted in accordance with the PRISMA guidelines which was registered at the PROSPERO Database (CRD42018086504). Randomized clinical trials (RCTs) involving critically ill patients with acute kidney injury (AKI) treated with continuous, intermittent or hybrid RRT were included. The search was performed using PubMed, Embase and Cochrane databases. RESULTS Out of 3442 citations retrieved, 12 RCTs were included in the systematic analysis, representing 1419 patients. Most studies (n = 8) did not report differences in hemodynamic parameters across different RTT modalities. The incidence of hypotensive episodes varied from 5 to 60% among the studies. Punctual differences on heart rate and blood pressure were observed among studies. However, studies presented high heterogeneity in terms of outcome definitions and measurement, thus making the conduction of meta-analysis impossible. CONCLUSIONS There is very few information available regarding hemodynamic tolerance of renal replacement therapy methods. A better standardization of hemodynamic tolerance and further reports are needed before conclusions can be drawn.
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Affiliation(s)
- Diana Silva Russo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | | | | | | | - Cassiano Teixeira
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Yvelynne P Kelly
- Division of Renal Medicine, Brigham and Women's Hospital, United States of America
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11
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Geer KD. Reconsidering the Trendelenburg position during intradialytic hypotension. Nursing 2022; 52:41-44. [PMID: 35196283 DOI: 10.1097/01.nurse.0000820060.94663.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Intradialytic hypotension (IDH) is the most common complication that patients experience during hemodialysis. This article discusses IDH and its emergency management, focusing on Trendelenburg position, which may create more risks than benefits.
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Affiliation(s)
- Kristine D Geer
- Kristine D. Geer is an RN with the Rochester Regional Health System in New York, N.Y
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12
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Donaldson L, Freund P, Aslahi R, Margolin E. Dialysis-Associated Nonarteritic Anterior Ischemic Optic Neuropathy: A Case Series and Review. J Neuroophthalmol 2022; 42:e116-e123. [PMID: 34974487 DOI: 10.1097/wno.0000000000001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dialysis-associated nonarteritic ischemic optic neuropathy (DA-NAION) occurs secondary to intradialytic hypotension often with catastrophic consequences and is one of the rare situations where NAION can recur in the same eye. We describe 3 cases of DA-NAION associated with hypotension, review the current literature on DA-NAION, and provide recommendations for decreasing the risk of intradialytic hypotension. METHODS In addition to describing 3 cases of DA-NAION, PubMed was searched for all reports of DA-NAION in adults with documented episodes of hypotension preceding the onset of NAION. A total of 50 eyes of 31 patients were included. Age, visual acuity at presentation, rate of bilateral involvement at presentation, sequential involvement of the fellow eye, and recurrence of NAION in the same eye were analyzed. RESULTS We found that most cases of DA-NAION occur in relatively young patients (47.7 ± 14.7 years) with a high rate of bilateral involvement at presentation (23%) and bilateral sequential involvement (39%). Vision loss is severe with 64% of patients presenting with 20/200 acuity or worse in the involved eye and 19% of patients with final visual acuity of 20/200 or worse in both eyes. 3 patients (9.7%) had recurrence of NAION in the previously affected eye. CONCLUSIONS Neuro-ophthalmologists have an important role in identifying patients who have suffered DA-NAION and communicating their findings to nephrologists to minimize the chance of involvement of the fellow eye and recurrence in the same eye. Intradialytic blood pressure must be closely monitored, and fluid balance, dialysate composition, and dialysis protocol must be optimized to prevent occurrence of intradialytic hypotension, which is the culprit for DA-NAION.
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Affiliation(s)
- Laura Donaldson
- Department of Ophthalmology and Vision Sciences (LD, PF, EM), University of Toronto, Toronto, Canada; Department of Medicine (RA), Division of Nephrology, University of Toronto, Toronto, Canada; and Department of Medicine (EM), Division of Neurology, University of Toronto, Toronto, Canada
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13
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Singh AT, Waikar SS, Mc Causland FR. Association of Different Definitions of Intradialytic Hypertension With Long-Term Mortality in Hemodialysis. Hypertension 2022; 79:855-862. [PMID: 35166122 PMCID: PMC8916991 DOI: 10.1161/hypertensionaha.121.18058] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension is common in hemodialysis patients. A subset of patients experience systolic blood pressure increases from prehemodialysis to posthemodialysis (intradialytic hypertension), which are associated with adverse outcomes. However, little consensus exists on an evidence-based definition. METHODS In 3198 hemodialysis patients, Cox models were fit to examine the association of various definitions of intradialytic hypertension (≥30% of baseline sessions with an increase in prehemodialysis to posthemodialysis systolic blood pressure of (1) ≥0 mm Hg [Hyper0]; (2) ≥10 mm Hg [Hyper10], or (3) ≥20 mm Hg increase [Hyper20]) with all-cause mortality. Effect modification was assessed using interaction terms according to prespecified variables. RESULTS At baseline, mean age was 62±15 years, 57% were male, and 14% were Black. During the baseline period, 47% of individuals met the Hyper0 definition and experienced 32% (hazard ratio, 1.32 [95% CI, 1.05-1.66]) higher adjusted risk of death, compared with no systolic blood pressure increase. Hyper10 was present in 21.2% and associated with 18% higher adjusted risk of death (hazard ratio, 1.18 [95% CI, 0.94-1.48]). Hyper20 was present in 6.8% and associated with 3% higher adjusted risk of death (hazard ratio 1.03 [95% CI, 0.74-1.44]). Effect modification by age and peripheral vascular disease was observed (P interaction=0.04 for age and 0.02 for peripheral vascular disease), with higher associated risk of death for those aged 45 to 70 years and those without peripheral vascular disease. CONCLUSIONS Individuals with any systolic blood pressure increase from prehemodialysis to posthemodialysis had the highest adjusted risk of mortality, compared with other threshold-based definitions.
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Affiliation(s)
- Anika T Singh
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.T.S., F.R.M.C.).,Harvard Medical School, Boston, MA (A.T.S., F.R.M.C.)
| | - Sushrut S Waikar
- Renal Section, Boston Medical Center, MA (S.S.W.).,Boston University School of Medicine (S.S.W.)
| | - Finnian R Mc Causland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.T.S., F.R.M.C.).,Harvard Medical School, Boston, MA (A.T.S., F.R.M.C.)
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14
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Rifai A, Soelistyoningsih D, Fajar JK, Gunawan A. Pre-dialytic Systolic Blood Pressure is an Independent Predictor of Intradialytic Hypertension. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Since endothelial dysfunction and activation of renin-angiotensin aldosterone system are the primary mechanism of intradialytic hypertension (IDHT), the assessment of pre dialytic blood pressure might provide an important information for the prediction of IDHT.
OBJECTIVES: To assess the association between pre dialytic blood pressure and the risk of IDHT.
METHODS: We conducted a cross-sectional study in Universitas Muhammadiyah Malang Hospital. The inclusion criteria were all hemodialysis patients aged more than 18 years, and the exclusion criteria were patients with hemodialysis duration of less than three months, patients with poor compliance to consume antihypertensive drugs, and hemodynamically unstable. The predictor variable was pre dialytic systolic blood pressure and the outcome was the incidence of IDHT. The association between pre dialytic blood pressure and the risk of IDHT was assessed using multiple logistic regression.
RESULTS: A total of 36 patients with IDHT and 60 patients without IDHT was enrolled in our study. Our study identified that pre dialytic systolic blood pressure was associated with the risk of IDHT, with mean difference was 10.90 mmHg between patients with IDHT and without IDHT. Our study confirmed that the levels of pre dialytic systolic blood pressure 135 mmHg was the optimal cut off, and we found that patients with pre dialytic systolic blood pressure ≥ 135 mmHg had 4.60-fold to develop IDHT compared to patients with pre dialytic systolic blood pressure < 135 mmHg.
CONCLUSION: Our study reveals that pre dialytic systolic blood pressure is an important predictor of IDHT.
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15
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Aoyama Y, Kajimoto K, Hori M, Otsubo S, Nitta K. Predicting factors of intradialytic hypotension in the last half of hemodialysis therapy. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intradialytic hypotension (IDH) is one of the most frequent complications of hemodialysis. IDH alters a patient’s quality of life and has a strong association with mortality. IDH mainly occurs when ultrafiltration during hemodialysis exceeds the pace of the plasma refill. Ultrasonography has been used to evaluate the intravascular volume status. We evaluated the association between IDH and baseline laboratory data or ultrasound findings during IDH during the latter half of a hemodialysis session.
Methods
Sixty-two patients who underwent hemodialysis were enrolled in this study. The peak early mitral inflow wave velocity (peak E-velocity), the inferior vena cava (IVC) dimensions, and number of B-lines were estimated at two time points (just after the start and at the midpoint of the hemodialysis session). We compared the parameters between the patients without IDH throughout the hemodialysis session (non-IDH group) and patients with IDH only during the latter half of the hemodialysis session (IDH in the latter half group).
Results
Of the 62 study participants, 28 patients were in non-IDH group, and 16 patients were in IDH in the latter half group. The serum sodium level was significantly lower in the IDH in the latter half group (135 ± 4 mEq/L) than in the non-IDH group (138 ± 4 mEq/L) (P = 0.015). The rate of decrease of the peak E-velocity was significantly higher in the IDH in the latter half group (0.33 ± 0.13) than in the non-IDH group (0.24 ± 0.14) (P = 0.037). The best cutoff point of the serum level of sodium was 137 mEq/L, with a sensitivity of 68.8% and specificity of 64.3%. The area under the receiver operating characteristic (ROC) curve was 0.71. The best cutoff point of the rate of decrease of the peak E-velocity was 0.295, with a sensitivity of 73.3% and a specificity of 71.4%. The area under the ROC curve was 0.71.
Conclusions
A low serum level of sodium at baseline and an early decrease in the peak E-velocity during hemodialysis may be related to intradialytic hypotension in the latter half of a hemodialysis session. Careful observation may be needed in the hemodialysis patients in whom the serum level of sodium is below 137 mEq/L or the rate of decrease of the peak E-velocity is over 0.295.
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16
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Yu J, Chen X, Li Y, Wang Y, Liu Z, Shen B, Teng J, Zou J, Ding X. High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study. Ren Fail 2021; 43:40-48. [PMID: 33307918 PMCID: PMC7745843 DOI: 10.1080/0886022x.2020.1853570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intradialytic-hypotension (IDH) is a common complication of hemodialysis. High ultrafiltration rate (UFR) might lead to IDH. However, the relationships between UFR, IDH, and cardiac remodeling among hemodialysis patients in the long-term have not been deeply explored. METHODS This retrospective cohort study collected clinical and echocardiographic data. Patients were enrolled from 1 January 2014 to 31 March 2014 and were followed-up for 5-year. Those who suffered from more than four hypotensive events during three months (10% of dialysis treatments) were defined as the IDH group. Subgroup analysis was done according to the UFR of 10 ml/h/kg. Associations between UFR, IDH, and alterations of cardiac structure/function were analyzed. RESULTS Among 209 patients, 96 were identified with IDH (45.9%). The survival rate of IDH patients was lower than that of no-IDH patients (65.5% vs. 81.4%, p = .005). In IDH group, decreased ejection fraction (EF), larger left atrium diameter index (LADI), and left ventricular mass index (LVMI) (p < .05) were observed at the end of the follow-up. In multivariate logistic model, the interaction between UFR and IDH was notably associated with LVMI variation (OR = 1.37). After adjusting covariates, UFR was still an independent risk factor of LVMI variation (OR = 1.52) in IDH group. In subsequent analysis, we divided patients according to UFR 10 ml/h/kg. For IDH-prone patients, decreased EF, larger LADI, and LVMI (p < .05) were observed at the end of the study only in high-UFR group. CONCLUSIONS UFR and IDH have interactions on cardiac remodeling. High ultrafiltration rate induced IDH is a predictor for cardiac remodeling in long-term follow-up.
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Affiliation(s)
- Jinbo Yu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Yang Li
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Yaqiong Wang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Jie Teng
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, P. R. China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, P. R. China
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17
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Wong A, Robinson L, Soroush S, Suresh A, Yang D, Madu K, Harhay MN, Pourrezaei K. Assessment of cerebral oxygenation response to hemodialysis using near-infrared spectroscopy (NIRS): Challenges and solutions. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2021; 14:2150016. [PMID: 35173820 PMCID: PMC8846418 DOI: 10.1142/s1793545821500164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To date, the clinical use of functional near-infrared spectroscopy (NIRS) to detect cerebral ischemia has been largely limited to surgical settings, where motion artifacts are minimal. In this study, we present novel techniques to address the challenges of using NIRS to monitor ambulatory patients with kidney disease during approximately eight hours of hemodialysis (HD) treatment. People with end-stage kidney disease who require HD are at higher risk for cognitive impairment and dementia than age-matched controls. Recent studies have suggested that HD-related declines in cerebral blood flow might explain some of the adverse outcomes of HD treatment. However, there are currently no established paradigms for monitoring cerebral perfusion in real-time during HD treatment. In this study, we used NIRS to assess cerebral hemodynamic responses among 95 prevalent HD patients during two consecutive HD treatments. We observed substantial signal attenuation in our predominantly Black patient cohort that required probe modifications. We also observed consistent motion artifacts that we addressed by developing a novel NIRS methodology, called the HD cerebral oxygen demand algorithm (HD-CODA), to identify episodes when cerebral oxygen demand might be outpacing supply during HD treatment. We then examined the association between a summary measure of time spent in cerebral deoxygenation, derived using the HD-CODA, and hemodynamic and treatment-related variables. We found that this summary measure was associated with intradialytic mean arterial pressure, heart rate, and volume removal. Future studies should use the HD-CODA to implement studies of real-time NIRS monitoring for incident dialysis patients, over longer time frames, and in other dialysis modalities.
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Affiliation(s)
- Ardy Wong
- Drexel University School of Bioengineering, Philadelphia, Pennsylvania
| | - Lucy Robinson
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Seena Soroush
- Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Aditi Suresh
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Dia Yang
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kelechi Madu
- Drexel University School of Bioengineering, Philadelphia, Pennsylvania
| | - Meera N. Harhay
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania
| | - Kambiz Pourrezaei
- Drexel University School of Bioengineering, Philadelphia, Pennsylvania
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18
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A maintenance hemodialysis mortality prediction model based on anomaly detection using longitudinal hemodialysis data. J Biomed Inform 2021; 123:103930. [PMID: 34624552 DOI: 10.1016/j.jbi.2021.103930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/05/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Most end-stage renal disease patients rely on hemodialysis (HD) to maintain their life, and they face a serious financial burden and high risk of mortality. Due to the current situation of the health care system in China, a large number of patients on HD are lost to follow-up, making the identification of patients with high mortality risks an intractable problem. OBJECTIVE This paper aims to propose a maintenance HD mortality prediction approach using longitudinal HD data under the situation of data imbalance caused by follow-up losses. METHODS A long short-term memory autoencoder (LSTM AE) based model is proposed to capture the physical condition changes of HD patients and distinguish between surviving and nonsurviving patients. The approach adopts anomaly detection theory, using only the surviving samples in the model training and identifying dead samples based on autoencoder reconstruction errors. The data are from a Chinese hospital electronic health record system between July 30, 2007, and August 25, 2016, and 36/72/108 continuous HD sessions were used to predict mortality within prediction windows of 90/180/365 days. Furthermore, the model performance is compared to that of logistic regression, support vector machine, random forest, LSTM classifier, isolation forest, and stacked autoencoder models. RESULTS Data for 1200 patients (survival: 1055, death: 145) were used to predict mortality during the next 90 days using 36 continuous HD sessions. The area under the PR curve for the LSTM AE was 0.57, the Recallmacro was 0.86, and the F1-scoremacro was 0.87, outperforming the other models. Upon varying the observation window or prediction window length, LSTM AE continued to outperform the other models. According to the variable importance analysis, the dialysis session length was the feature that contributed the most to the prediction model. CONCLUSIONS The proposed approach was able to detect patients on maintenance HD with high mortality risk from an imbalanced dataset using anomaly detection theory and leveraging longitudinal HD data.
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19
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Yu J, Chen X, Li Y, Wang Y, Cao X, Liu Z, Shen B, Zou J, Ding X. Pro-inflammatory cytokines as potential predictors for intradialytic hypotension. Ren Fail 2021; 43:198-205. [PMID: 33459124 PMCID: PMC7833080 DOI: 10.1080/0886022x.2021.1871921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Intradialytic hypotension (IDH) is a common complication in maintaining hemodialysis (MHD) patients. Immune activation might be part of the mechanisms. However, the association between pro-inflammatory cytokines and blood pressure (BP) has not been deeply explored. So we aim to evaluate the potential role of pro-inflammatory cytokines in IDH. Methods MHD patients starting hemodialysis before January 2016 were enrolled in our retrospective study. Patients' characteristics, laboratory results, and intradialytic BP were collected. IDH was defined as nadir systolic BP ≤ 90 mmHg during hemodialysis. The definition of IDH group was that those who suffered from more than one hypotensive event during one month after the enrollment (10% of dialysis treatments). Spearman correlation analysis and logistic regression were employed to explore the relationship between pro-inflammatory cytokines and IDH. Results Among 390 patients, 72 were identified with IDH (18.5%). High levels of serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were observed in the IDH group (p < 0.001). Both TNF-α and IL-1β positively correlated with predialysis BP (p < 0.01). Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic accuracy of serum IL-1β and TNF-α for IDH. The area under the curve of IL-1β was 0.772 (95% CI: 0.708-0.836, p < 0.01), and that of TNF-α was 0.701 (95% CI: 0.620-0.781, p < 0.01). After adjusting for patients' characteristics, biochemical parameters, comorbid conditions, predialysis BP, and medications, elevated TNF-α and IL-1β were still risk factors for IDH. Conclusion Pro-inflammatory cytokines (TNF-α and IL-1β) could be potential predictors for IDH.
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Affiliation(s)
- Jinbo Yu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Yang Li
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Yaqiong Wang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xuesen Cao
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, PR China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, PR China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, PR China
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20
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Singh AT, Mothi SS, Li P, Sabbisetti V, Waikar SS, Mc Causland FR. Endothelin-1 and Parameters of Systolic Blood Pressure in Hemodialysis. Am J Hypertens 2021; 34:1203-1208. [PMID: 34192305 PMCID: PMC9526807 DOI: 10.1093/ajh/hpab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hypertension is common in hemodialysis (HD) patients. Increased blood pressure (BP) variability, particularly higher and lower extremes, is associated with adverse outcomes. We explored the association of endothelin-1 (ET-1), a potent vasoconstrictor, with different BP parameters (pre-HD, intra-HD, and post-HD) during HD in a contemporary patient cohort. METHODS This study uses the DaVita Biorepository, a longitudinal prospective cohort study with quarterly collection of clinical data and biospecimens. Unadjusted and adjusted linear mixed effects regression models were fit to determine association of pre-HD ET-1 (log-transformed and quartiles) with HD-related systolic BP (SBP) parameters (pre-HD, nadir intra-HD, and post-HD). As ET-1 was measured at baseline, analyses were restricted to 1 year of follow-up. RESULTS Among 769 participants, mean age was 52 years, 42% were females, and 41% were Black. Mean pre-HD SBP was 152 (±28) mm Hg and mean ET-1 concentration was 2.3 (±1.2) ng/ml. In fully adjusted models, each unit increase in SD of log-transformed ET-1 was associated with a 2.7 (95% confidence interval [CI] 1.5, 4.0) mm Hg higher pre-SBP; 1.6 (95% CI 0.9, 2.3) mm Hg higher nadir SBP; and 2.0 (95% CI 1.1, 2.9) mm Hg higher post-SBP. Each SD increase in log-transformed ET-1 was associated with 21% higher odds of experiencing intradialytic hypertension (odds ratio 1.21; 95% CI 1.10-1.34). CONCLUSIONS Higher baseline ET-1 levels are independently associated with higher SBP and higher odds of intradialytic hypertension. These results highlight a potential role for ET-1 in BP control in HD patients and raise the possibility of ET-1 antagonism as a therapeutic target.
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Affiliation(s)
- Anika T Singh
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Correspondence: Anika T. Singh ()
| | - Suraj Sarvode Mothi
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Ping Li
- Department of Nephrology, State Key Laboratory of Kidney Disease, National Clinical Research Center for Kidney Disease, Chinese PLA General Hospital, Beijing, PR China
| | - Venkata Sabbisetti
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
| | - Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts, USA
| | - Finnian R Mc Causland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
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21
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Hryciw N, Joannidis M, Hiremath S, Callum J, Clark EG. Intravenous Albumin for Mitigating Hypotension and Augmenting Ultrafiltration during Kidney Replacement Therapy. Clin J Am Soc Nephrol 2021; 16:820-828. [PMID: 33115729 PMCID: PMC8259476 DOI: 10.2215/cjn.09670620] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Among its many functions, owing to its oversized effect on colloid oncotic pressure, intravascular albumin helps preserve the effective circulatory volume. Hypoalbuminemia is common in hospitalized patients and is found especially frequently in patients who require KRT either for AKI or as maintenance hemodialysis. In such patients, hypoalbuminemia is strongly associated with morbidity, intradialytic hypotension, and mortality. Intravenous albumin may be administered in an effort to prevent or treat hypotension or to augment fluid removal, but this practice is controversial. Theoretically, intravenous albumin administration might prevent or treat hypotension by promoting plasma refilling in response to ultrafiltration. However, clinical trials have demonstrated that albumin administration is not nearly as effective a volume expander as might be assumed according to its oncotic properties. Although intravenous albumin is generally considered to be safe, it is also very expensive. In addition, there are potential risks to using it to prevent or treat intradialytic hypotension. Some recent studies have suggested that hyperoncotic albumin solutions may precipitate or worsen AKI in patients with sepsis or shock; however, the overall evidence supporting this effect is weak. In this review, we explore the theoretical benefits and risks of using intravenous albumin to mitigate intradialytic hypotension and/or enhance ultrafiltration and summarize the current evidence relating to this practice. This includes studies relevant to its use in patients on maintenance hemodialysis and critically ill patients with AKI who require KRT in the intensive care unit. Despite evidence of its frequent use and high costs, at present, there are minimal data that support the routine use of intravenous albumin during KRT. As such, adequately powered trials to evaluate the efficacy of intravenous albumin in this setting are clearly needed.
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Affiliation(s)
- Nicole Hryciw
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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22
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Jeong HY, Kim HJ, Han M, Seong EY, Song SH. Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients. Ther Apher Dial 2021; 26:103-114. [PMID: 33774930 DOI: 10.1111/1744-9987.13648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period. ABPM was performed once for 24 h in the absence of dialysis during the final 2 weeks of the study period and was compared to the 2-week dialysis unit BP and home BP. There was a significant difference between dialysis unit systolic blood pressure (SBP) and home SBP over the 9-month period. No significant difference was observed between the 2hr-HD SBP and home SBP. When analyzing 2 weeks of dialysis unit BP and home BP, including ABPM, SBPs were significantly different (dialysis unit BP > home BP > ABPM; P = 0.009). Consistent with the 9-month study period, no significant difference was observed between 2hr-HD SBP and home SBP (P = 0.809). The difference between 2hr-HD SBP and ambulatory SBP was not significant (P = 0.113). In conclusion, the 2hr-HD SBP might be useful for predicting home BP and ABPM in HD patients.
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Affiliation(s)
- Hye Yun Jeong
- Department of Internal Medicine, Jeonggwan Ilsin Christian Hospital, Busan, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Miyeun Han
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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23
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Stewart J, Stewart P, Walker T, Viramontes-Hörner D, Lucas B, White K, Taal MW, Selby NM, Morris M. An iterative run-to-run learning model to derive continuous brachial pressure estimates from arterial and venous lines during dialysis treatment. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Intradialytic systolic blood pressure variation can predict long-term mortality in patients on maintenance hemodialysis. Int Urol Nephrol 2021; 53:785-795. [PMID: 33387229 DOI: 10.1007/s11255-020-02701-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE It is unclear which time-points of intradialytic blood pressure (BP) best predict prognosis. Thus, it is important to assess the association between different time-points of intradialytic BP and prognosis in clinical practice. METHODS We recruited patients who underwent hemodialysis from January 2014 to June 2014. Data about dialysis were collected, including intradialytic BP. Cox regression analysis was performed to examine the association between different time-points of intradialytic BP and clinical events, with a follow-up through December 31, 2019. The primary endpoint was all-cause mortality. RESULTS A total of 216 patients were recruited and 62 (30.7%) patients died (6.1 per 100-person year) during the follow-up. Intradialytic SBP varied greatly in fatalities. Univariate and multivariate Cox regression models indicated that the adjusted hazard ratio for death was 1.80 and 5.06 when intradialytic systolic blood pressure (SBP) variation was analyzed in increments of 20 mmHg. Furthermore, we divided intradialytic SBP variation into three categories: < 15 mmHg, 15 ~ 30 mmHg, ≥ 30 mmHg. Kaplan-Meier analysis indicated that both all-cause mortality and cardiovascular mortality increased significantly for patients with intradialytic SBP variation over 30 mmHg (P = 0.006 and 0.021). Univariate and multivariate Cox regression models indicated that the adjusted hazard ratio for death was 3.78 and 12.62 as intradialytic SBP variation ≥ 30 mmHg vs. intradialytic SBP variation < 15 mmHg. CONCLUSION Intradialytic SBP variation, rather than BP of specific intradialytic time-points, has the potential to predict long-term mortality in hemodialysis patients. BP stability is crucial for patients' prognosis.
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25
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Bansal N, Glidden DV, Mehrotra R, Townsend RR, Cohen J, Linke L, Palad F, Larson H, Hsu CY. Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial. Am J Kidney Dis 2021; 77:12-22. [PMID: 32800842 PMCID: PMC7752836 DOI: 10.1053/j.ajkd.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/11/2020] [Indexed: 01/13/2023]
Abstract
RATIONALE & OBJECTIVE Observational studies have reported a U-shaped association between blood pressure (BP) before a hemodialysis session and death. In contrast, because a linear association between out-of-dialysis-unit BP and death has been reported, home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home versus predialysis BP in hemodialysis patients. STUDY DESIGN A 4-month, parallel, randomized, controlled trial. SETTINGS & PARTICIPANTS 50 prevalent hemodialysis patients in San Francisco and Seattle. Participants were randomly assigned using 1:1 block randomization, stratified by site. INTERVENTIONS To target home systolic BP (SBP) of 100-<140 mm Hg versus predialysis SBP of 100-<140mm Hg. Home and predialysis SBPs were ascertained every 2 weeks. Dry weight and BP medications were adjusted to reach the target SBP. OUTCOMES Primary outcomes were feasibility, adherence, safety. and tolerability. RESULTS 50 of 70 (71%) patients who were approached agreed to participate. All enrollees completed the study except for 1 who received a kidney transplant. In the home BP treatment group, adherence to obtaining/reporting home BP was 97.4% (and consistent over the 4 months). There was no increased frequency of high (defined as SBP>200mm Hg; 0.2% vs 0%) or low (defined as<90mm Hg; 1.8% vs 1.2%) predialysis BP readings in the home versus predialysis treatment arms, respectively. However, participants in the home BP arm had higher frequency of fatigue (32% vs 16%). LIMITATIONS Small sample size. CONCLUSIONS This pilot trial demonstrates feasibility and high adherence to home BP measurement and treatment in hemodialysis patients. Larger trials to test the long-term feasibility, efficacy, and safety of home BP treatment in hemodialysis patients should be conducted. FUNDERS National Institutes of Health, Satellite Healthcare, and Northwest Kidney Centers. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03459807.
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Affiliation(s)
- Nisha Bansal
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA.
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Rajnish Mehrotra
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | | | - Jordana Cohen
- Division of Nephrology, University of Pennsylvania, Philadelphia, PA
| | - Lori Linke
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA
| | - Farshad Palad
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
| | - Hannah Larson
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco, San Francisco, CA
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26
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The effect of foot massage in lowering intradialytic blood pressure at Hemodialysis Unit in Indonesian Hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Stewart J, Stewart P, Walker T, Horner DV, Lucas B, White K, Muggleton A, Morris M, Selby NM, Taal MW. A Feasibility Study of Non-Invasive Continuous Estimation of Brachial Pressure Derived From Arterial and Venous Lines During Dialysis. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 9:2700209. [PMID: 33200053 PMCID: PMC7665243 DOI: 10.1109/jtehm.2020.3035988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/07/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
Objective: Intradialytic haemodynamic instability is a significant clinical problem, leading to end-organ ischaemia and contributing to morbidity and mortality in haemodialysis patients. Non-invasive continuous blood pressure monitoring is not currently part of routine practice but may aid detection and prevention of significant falls in blood pressure during dialysis. Brachial blood pressure is currently recorded intermittently during haemodialysis via a sphygmomanometer. Current methods of continuous non-invasive blood pressure monitoring tend to restrict movement, can be sensitive to external disturbances and patient movement, and can be uncomfortable for the wearer. Additionally, poor patient blood circulation can lead to unreliable measurements. In this feasibility study we performed an initial validation of a novel method and associated technology to continuously estimate blood pressure using pressure sensors in the extra-corporeal dialysis circuit, which does not require any direct contact with the person receiving dialysis treatment. Method: The paper describes the development of the measurement system and subsequent in vivo patient feasibility study with concurrent measurement validation by Finapres Nova physiological measurement device. Real-time physiological data is collected over the entire period of (typically 4-hour) dialysis treatment. Results: We identify a quasi-linear mathematical function to describe the relationship between arterial line pressure and brachial artery BP, which is confirmed in a patient study. The results from this observational study suggest that it is feasible to derive a continuous measurement of brachial pressure from continuous measurements of arterial and venous line pressures via an empirically based and updated mathematical model. Conclusion: The methodology presented requires no interfacing to proprietary dialysis machine systems, no sensors to be attached to the patient directly, and is robust to patient movement during treatment and also to the effects of the cyclical pressure waveforms induced by the hemodialysis peristaltic blood pump. This represents a key enabling factor to the development of a practical continuous blood pressure monitoring device for dialysis patients.
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Affiliation(s)
- Jill Stewart
- School of Health and Social CareUniversity of DerbyDerbyDE22 1GBU.K
| | - Paul Stewart
- School of Health and Social CareUniversity of DerbyDerbyDE22 1GBU.K
| | - Thomas Walker
- School of Health and Social CareUniversity of DerbyDerbyDE22 1GBU.K
| | - Daniela Viramontes Horner
- Centre for Kidney Research and InnovationUniversity of NottinghamNottinghamNG7 2RDU.K.,Renal UnitRoyal Derby HospitalDerbyDE22 3NEU.K
| | - Bethany Lucas
- Centre for Kidney Research and InnovationUniversity of NottinghamNottinghamNG7 2RDU.K.,Renal UnitRoyal Derby HospitalDerbyDE22 3NEU.K
| | - Kelly White
- Renal UnitRoyal Derby HospitalDerbyDE22 3NEU.K
| | | | - Mel Morris
- MStart Foundation and iTrend Medical Research Ltd.DerbyDE24 8DZU.K
| | - Nicholas M Selby
- Centre for Kidney Research and InnovationUniversity of NottinghamNottinghamNG7 2RDU.K.,Renal UnitRoyal Derby HospitalDerbyDE22 3NEU.K
| | - Maarten W Taal
- Centre for Kidney Research and InnovationUniversity of NottinghamNottinghamNG7 2RDU.K.,Renal UnitRoyal Derby HospitalDerbyDE22 3NEU.K
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28
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Huang JC, Tsai YC, Wu PY, Lien YH, Chien CY, Kuo CF, Hung JF, Chen SC, Kuo CH. Predictive modeling of blood pressure during hemodialysis: a comparison of linear model, random forest, support vector regression, XGBoost, LASSO regression and ensemble method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 195:105536. [PMID: 32485511 DOI: 10.1016/j.cmpb.2020.105536] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intradialytic hypotension (IDH) is commonly occurred and links to higher mortality among patients undergoing hemodialysis (HD). Its early prediction and prevention will dramatically improve the quality of life. However, predicting the occurrence of IDH clinically is not simple. The aims of this study are to develop an intelligent system with capability of predicting blood pressure (BP) during HD, and to further compare different machine learning algorithms for next systolic BP (SBP) prediction. METHODS This study presented comprehensive comparisons among linear regression model, least absolute shrinkage and selection operator (LASSO), tree-based ensemble machine learning models (random forest [RF] and extreme gradient boosting [XGBoost]), and support vector regression to predict the BP during HD treatment based on 200 and 48 maintenance HD patients containing a total of 7,180 and 2,065 BP records for the training and test dataset, respectively. Ensemble method also was computed to obtain better predictive performance. We compared the developed models based on R2, root mean square error (RMSE) and mean absolute error (MAE). RESULTS We found that RF (R2=0.95, RMSE=6.64, MAE=4.90) and XGBoost (R2=1.00, RMSE=1.83, MAE=1.29) had comparable predictive performance on the training dataset. However, RF (R2=0.49, RMSE=16.24, MAE=12.14) had more accurate than XGBoost (R2=0.41, RMSE=17.65, MAE=13.47) on testing dataset. Among these models, the ensemble method (R2=0.50, RMSE=16.01, MAE=11.97) had the best performance on testing dataset for next SBP prediction. CONCLUSIONS We compared five machine learning and an ensemble method for next SBP prediction. Among all studied algorithms, the RF and the ensemble method have the better predictive performance. The prediction models using ensemble method for intradialytic BP profiling may be able to assist the HD staff or physicians in individualized care and prompt intervention for patients' safety and improve care of HD patients.
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Affiliation(s)
- Jiun-Chi Huang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | - Chih-Feng Kuo
- Graduate Institute of Science Education and Environmental Education, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Jeng-Fung Hung
- Graduate Institute of Science Education and Environmental Education, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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29
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Halle MP, Hilaire D, Francois KF, Denis T, Hermine F, Gloria AE. Intradialytic hypotension and associated factors among patients on maintenance hemodialysis: A single-center study in cameroon. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:215-223. [PMID: 32129216 DOI: 10.4103/1319-2442.279944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intradialytic hypotension (IDH), one of the most frequent acute complications of hemodialysis (HD), is associated with increased patient's morbidity and mortality. The aim of this study was to determine its prevalence and associated factors among patients on maintenance HD in Cameroon. This was a prospective longitudinal study carried out from June 20, to July 30, 2016 (5 weeks), including adult patients on HD >3 months at a tertiary hospital in Douala. During this period, patients were followed up at each HD session, and their blood pressure and occurrence of clinical events possibly related to IDH were recorded. In this study, IDH was defined as a decrease in systolic BP by >20 mm Hg or a decrease in mean arterial pressure by >10 mm Hg, associated to a clinical event. Logistic regression analysis was used to determine associated factors. We included 104 patients (69 males) with a mean age of 50.74 ± 15.18 years and a median duration on HD of 30.5 (interquartile range: 12.25-58.75) years. Hypertension 99/104 (95.2%) and diabetes 32/104 (30.8%) were the main comorbidities encountered. A total of 1032 HD sessions were followed up with an average of 9.88 ± 1.57 sessions per patient. IDH occurred in 11.6% of HD sessions. Associated factors were age, female sex, HIV infection, feeding during dialysis, and use of antihypertensive drug during or within 2 h before dialysis. The prevalence of IDH in our study was low. Associated factors were mainly related to patient's characteristics and comorbidities.
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Affiliation(s)
- Marie Patrice Halle
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala; Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Djantio Hilaire
- Department of Clinical Sciences, Higher Institute of Health Sciences, Université des Montagnes, Bangangte, Cameroon
| | - Kaze F Francois
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I; Department of Internal Medicine, Yaounde Teaching Hospital, Yaounde, Cameroon
| | - Teuwafeu Denis
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Fouda Hermine
- Department of Internal Medicine, Douala General Hospital, Douala; Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Ashuntantang E Gloria
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I; Department of Internal Medicine, Yaounde General Hospital, Yaounde, Cameroon
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30
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Successful kidney transplantation from a deceased donor to a recipient with chronic intradialytic hypotension (clinical case report). TRANSPLANTATION REPORTS 2020. [DOI: 10.1016/j.tpr.2019.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Yeo S, Moon JI, Shin J, Hwang JH, Cho I, Kim SH. Impacts of Coronary Artery Calcification on Intradialytic Blood Pressure Patterns in Patients Receiving Maintenance Hemodialysis. Chonnam Med J 2020; 56:27-35. [PMID: 32021839 PMCID: PMC6976763 DOI: 10.4068/cmj.2020.56.1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressure – minimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre- to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.
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Affiliation(s)
- Seongyup Yeo
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji In Moon
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jungho Shin
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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32
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Calderón-Juárez M, González-Gómez GH, Echeverría JC, Pérez-Grovas H, Lerma C. Association between Mean Heart Rate and Recurrence Quantification Analysis of Heart Rate Variability in End-Stage Renal Disease. ENTROPY 2020; 22:e22010114. [PMID: 33285890 PMCID: PMC7516420 DOI: 10.3390/e22010114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 01/09/2023]
Abstract
Linear heart rate variability (HRV) indices are dependent on the mean heart rate, which has been demonstrated in different models (from sinoatrial cells to humans). The association between nonlinear HRV indices, including those provided by recurrence plot quantitative analysis (RQA), and the mean heart rate (or the mean cardiac period, also called meanNN) has been scarcely studied. For this purpose, we analyzed RQA indices of five minute-long HRV time series obtained in the supine position and during active standing from 30 healthy subjects and 29 end-stage renal disease (ESRD) patients (before and after hemodialysis). In the supine position, ESRD patients showed shorter meanNN (i.e., faster heart rate) and decreased variability compared to healthy subjects. The healthy subjects responded to active standing by shortening the meanNN and decreasing HRV indices to reach similar values of ESRD patients. Bivariate correlations between all RQA indices and meanNN were significant in healthy subjects and ESRD after hemodialysis and for most RQA indices in ESRD patients before hemodialysis. Multiple linear regression analyses showed that RQA indices were also dependent on the position and the ESRD condition. Then, future studies should consider the association among RQA indices, meanNN, and these other factors for a correct interpretation of HRV.
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Affiliation(s)
- Martín Calderón-Juárez
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | | | - Juan C. Echeverría
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City 09340, Mexico;
| | - Héctor Pérez-Grovas
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
- Correspondence: ; Tel.: +52-55-55732911 (ext. 26202)
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33
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Alvarez L, Brown D, Hu D, Chertow GM, Vassalotti JA, Prichard S. Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey. Kidney Med 2019; 2:125-130. [PMID: 32734233 PMCID: PMC7380355 DOI: 10.1016/j.xkme.2019.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Rationale & Objective Patients experience various symptoms during hemodialysis. We aimed to assess the frequency and severity of symptoms during hemodialysis and whether intradialytic symptoms are associated with recovery time postdialysis. Study Design An online questionnaire was sent to 10,000 patients in a National Kidney Foundation database. Setting & Participants Adult patients receiving in-center hemodialysis 3 times weekly for 3 or more months. Exposure Online questionnaire. Analytic Approach Tabulation of frequency and severity of events and recovery time as percent of respondents, construction of a total symptom score, followed by rank correlation analysis of symptom characteristics with total recovery time. Outcomes Patient-reported intradialytic symptoms and recovery time postdialysis. Results 359 patients met screening criteria and completed the questionnaire. Mean age was 62.5 ± 13.8 years, 207 (58%) were men, 74 (21%) were black/African American, 132 (37%) had diabetes, 252 (70%) had hypertension, and 102 (28%) had a history of myocardial infarction, heart surgery, or stent placement. 311 (87%) patients had symptoms during dialysis in the previous week, with mean severity of 2.7 (range for each symptom, 1-5). The most common symptoms were fatigue/feeling washed out (62%), cramps (44%), and symptoms of low blood pressure (42%). Median time to recovery was 3 (range, 0-24) hours, and this correlated with the incidence and severity of intradialytic symptoms (P < 0.0001). 40% of patients had time to recovery times of 4 hours or longer. 1 in 3 patients reported having stopped dialysis early for intradialytic symptoms and 6% reported skipping dialysis at least once because of intradialytic symptoms. Limitations Recall-based self-reported data with a relatively low response rate. Conclusions A majority of patients receiving in-center hemodialysis experience symptoms such as feeling washed out, fatigue, and cramping; these may be severe and are correlated with longer recovery time following hemodialysis, as well as shortened and skipped hemodialysis sessions.
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Affiliation(s)
| | | | - Dean Hu
- Outset Medical Inc, San Jose, CA
| | | | - Joseph A Vassalotti
- Icahn School of Medicine at Mount Sinai, New York, NY.,National Kidney Foundation, Inc, New York, NY
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Wang F, Wang Y, Tian Y, Zhang P, Chen J, Li J. Pattern recognition and prognostic analysis of longitudinal blood pressure records in hemodialysis treatment based on a convolutional neural network. J Biomed Inform 2019; 98:103271. [DOI: 10.1016/j.jbi.2019.103271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/11/2019] [Accepted: 08/23/2019] [Indexed: 11/15/2022]
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Flythe JE, Bansal N. The relationship of volume overload and its control to hypertension in hemodialysis patients. Semin Dial 2019; 32:500-506. [PMID: 31564065 DOI: 10.1111/sdi.12838] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hypertension is highly prevalent and associated with poor clinical outcomes among individuals receiving maintenance hemodialysis (HD). Volume overload is a key modifiable contributor to hypertension and cardiovascular disease in the HD population. Despite their importance, assessment and treatment of volume overload and hypertension remain major clinical challenges and have substantial implications for both clinical outcomes and patient experiences of care. This review will summarize current data on the diagnosis, epidemiology, pathophysiology, and clinical consequences of hypertension and volume overload in HD patients. We will also identify priorities for future research studies.
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Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Nisha Bansal
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.,Kidney Research Institute, University of Washington, Seattle, Washington
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Abstract
Allowing dialysis patients to eat during the treatment is controversial. It is, therefore, no surprise that practices and policies with respect to intradialytic food consumption vary considerably from unit to unit and from country to country. Those who defend the position of feeding during dialysis reason that intradialytic meals offer a supervised and effective therapy for protein-energy wasting. Those who take the opposite view argue that intradialytic food intake should be avoided for the following three reasons. First, interventional studies show that eating during dialysis causes a clinically significant reduction in systemic blood pressure during the postprandial period and elevates the risk of symptomatic intradialytic hypotension; the latter is associated with increased mortality risk. Second, clinical studies have shown that eating during dialysis interferes with the adequacy of the delivered dialysis, whereas eating 2-3 h before the dialysis session has no impact on the efficiency of the subsequent dialysis treatment. And third, randomized studies show that eating during dialysis focus on the positive outcomes but do not adequately balance this potential benefit against the risk of intradialytic hemodynamic instability and poor quality of delivered dialysis. Even after half a century of providing long-term dialysis, definitive randomized trials that balance risks and benefits of eating during dialysis are missing. These knowledge gaps require randomized trials. Since there is a real possibility of harm with eating during dialysis, we caution that instead of encouraging the widespread use of intradialytic meals, practices and policies should focus on adequate nutrient intake during the interdialytic interval.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Panagiotis Georgianos
- Division of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Meyring-Wösten A, Luo Y, Zhang H, Preciado P, Thijssen S, Wang Y, Kotanko P. Intradialytic hypertension is associated with low intradialytic arterial oxygen saturation. Nephrol Dial Transplant 2019; 33:1040-1045. [PMID: 29186549 PMCID: PMC5982811 DOI: 10.1093/ndt/gfx309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background The pathophysiology of a paradoxical systolic blood pressure (SBP) rise during hemodialysis (HD) is not yet fully understood. Recent research indicated that 10% of chronic HD patients suffer from prolonged intradialytic hypoxemia. Since hypoxemia induces a sympathetic response we entertained the hypothesis that peridialytic SBP change is associated with arterial oxygen saturation (SaO2). Methods We retrospectively analyzed intradialytic SaO2 and peridialytic SBP change in chronic HD patients with arteriovenous vascular access. Patients were followed for 6 months. We defined persistent intradialytic hypertension (piHTN) as average peridialytic SBP increase ≥10 mmHg over 6 months. Linear mixed effects (LME) models were used to explore associations between peridialytic SBP change and intradialytic SaO2 in univariate and adjusted analyses. Results We assessed 982 patients (29 872 HD treatments; 59% males; 53% whites). Pre-dialysis SBP was 146.7 ± 26.5 mmHg and decreased on average by 10.1 ± 24.5 mmHg. Fifty-three (5.7%) patients had piHTN. piHTN patients had lower intradialytic SaO2, body weight and interdialytic weight gain. LME models revealed that with every percentage point lower mean SaO2, the peridialytic SBP change increased by 0.46 mmHg (P < 0.001). This finding was corroborated in multivariate analyses. Conclusion We observed an inverse relationship between intradialytic SaO2 and the blood pressure response to HD. These findings support the notion that hypoxemia activates mechanisms that partially blunt the intradialytic blood pressure decline, possibly by sympathetic activation and endothelin-1 secretion. To further explore that hypothesis, specifically designed prospective studies are required.
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Affiliation(s)
| | - Ya Luo
- University of California at Santa Barbara, Department of Statistics and Applied Probability, Santa Barbara, CA, USA
| | - Hanjie Zhang
- Renal Research Institute, Research Department, New York, NY, USA
| | | | - Stephan Thijssen
- Renal Research Institute, Research Department, New York, NY, USA
| | - Yuedong Wang
- University of California at Santa Barbara, Department of Statistics and Applied Probability, Santa Barbara, CA, USA
| | - Peter Kotanko
- Renal Research Institute, Research Department, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Okpa HO, Effa EE, Oparah SK, Chikezie JA, Bisong EM, Mbu PN, Otokpa DE. Intradialysis blood pressure changes among chronic kidney disease patients on maintenance haemodialysis in a tertiary hospital south - south Nigeria: a 2 year retrospective study. Pan Afr Med J 2019; 33:91. [PMID: 31489069 PMCID: PMC6711679 DOI: 10.11604/pamj.2019.33.91.17000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/16/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods This was a retrospective study that reviewed chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria. In all, 71 patients were reviewed but only 64 patients had complete data for analysis. Socio-demographic, clinical and biochemical data were obtained from the records in the dialysis unit. Results There were more males 38 (59.4%) than females 26 (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension 29 (45.3%) was higher than that of intradialysis hypotension 20 (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetic nephropathy. The factors associated with intradialysis hypotension were lower post-dialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the factors associated with intradialysis hypertension were higher post-dialysis systolic blood pressure (SBP), MAP, greater number of antihypertensive medications and longer duration of haemodialysis. Conclusion Our study shows that there are several modifiable factors associated with blood pressure fluctuations among CKD patients on maintenance haemodialysis in the renal unit of the University of Calabar Teaching Hospital, Calabar.
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Affiliation(s)
- Henry Ohem Okpa
- Department of Internal Medicine, Renal Unit, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Emmanuel Edet Effa
- Department of Internal Medicine, Renal Unit, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | | | - John Austin Chikezie
- Department of Internal Medicine, Abia State University, Uturu, Nigeria.,Renal Unit, Abia State University Teaching Hospital, Aba, Nigeria
| | - Elvis Mbu Bisong
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
| | - Patrick Ntui Mbu
- Department of Internal Medicine, Renal Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Daniel Emmanuel Otokpa
- Department of Internal Medicine, Renal Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
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Kuipers J, Verboom LM, Ipema KJR, Paans W, Krijnen WP, Gaillard CAJM, Westerhuis R, Franssen CFM. The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis. Am J Nephrol 2019; 49:497-506. [PMID: 31129661 DOI: 10.1159/000500877] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/24/2019] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
| | - Loes M Verboom
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin J R Ipema
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolter Paans
- Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
| | - Wim P Krijnen
- Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
| | - Carlo A J M Gaillard
- Division of Internal Medicine and Dermatology, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Casper F M Franssen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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40
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Wang KM, Sirich TL, Chang TI. Timing of blood pressure medications and intradialytic hypotension. Semin Dial 2019; 32:201-204. [PMID: 30836447 DOI: 10.1111/sdi.12777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Intradialytic hypotension (IDH) is a prevalent yet serious complication of hemodialysis, associated with decreased quality of life, inadequate dialysis, vascular access thrombosis, global hypoperfusion, and increased cardiovascular and all-cause mortality. Current guidelines recommend antihypertensive medications be given at night and held the morning of dialysis for affected patients. Despite little evidence to support this recommendation, more than half of patients on dialysis may employ some form of this method. In this article, we will review the available evidence and clinical considerations regarding timing of blood pressure medications and occurrence of IDH, and conclude that witholding BP medications before hemodialysis should not be a routine practice.
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Affiliation(s)
- Katherine M Wang
- Department of Medicine, Stanford Division of Nephrology, Palo Alto, California
| | - Tammy L Sirich
- Department of Medicine, Stanford Division of Nephrology, Palo Alto, California.,Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California
| | - Tara I Chang
- Department of Medicine, Stanford Division of Nephrology, Palo Alto, California
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Chou JA, Streja E, Nguyen DV, Rhee CM, Obi Y, Inrig JK, Amin A, Kovesdy CP, Sim JJ, Kalantar-Zadeh K. Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients. Nephrol Dial Transplant 2018; 33:149-159. [PMID: 28444336 DOI: 10.1093/ndt/gfx037] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/06/2017] [Indexed: 12/15/2022] Open
Abstract
Background Intradialytic hypotension (IDH) occurs frequently in maintenance hemodialysis (HD) patients and may be associated with higher mortality. We hypothesize that nadir intradialytic systolic blood pressure (niSBP) is inversely related to death risk while iSBP change (Δ) and IDH frequency are incrementally associated with all-cause mortality. Methods In a US-based cohort of 112 013 incident HD patients over a 5-year period (2007-11), using niSBP, ΔiSBP (pre-HD SBP minus niSBP) and IDH frequency (proportion of HD treatments with niSBP <90 mmHg) within the first 91 days of HD, we examined mortality-predictability at 1, 2 and 5 years using Cox models and restricted cubic splines adjusted for case-mix, comorbidities and laboratory covariates. Results We observed that niSBP of <90 and ≥140 mmHg had a 5-year mortality hazard ratio (HR) (95% confidence interval) of 1.57 (1.47-1.67) and 1.25 (1.18-1.33), respectively, compared with niSBP 110 to <120 mmHg. ΔiSBP of <15 and ≥50 compared with 21-30 mmHg had mortality HR of 1.31 (1.26-1.37) and 1.32 (1.24-1.39), respectively. Among patients with >40% IDH frequency, we observed a mortality HR of 1.49 (1.42-1.57) compared with 0% IDH frequency in fully adjusted models. These associations were robust at 1 and 2 years of follow-up. Conclusion In conclusion, we observed a U-shaped association between niSBP and ΔiSBP and mortality and a direct linear relationship between IDH frequency and mortality. Our findings lend some prognostic insight of HD blood pressure and hemodynamics, and have the potential to guide blood pressure management strategies among the HD population.
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Affiliation(s)
- Jason A Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Danh V Nguyen
- Department of Medicine, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Jula K Inrig
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.,Quintiles Therapeutic Science and Strategy Unit, San Diego, California
| | - Alpesh Amin
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Medical Center, Los Angeles, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.,Fielding School of Public Health at UCLA, Los Angeles, CA, USA.,Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
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Kooman JP, Usvyat LA, Dekker MJE, Maddux DW, Raimann JG, van der Sande FM, Ye X, Wang Y, Kotanko P. Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine? Blood Purif 2018; 47:171-184. [PMID: 30448825 DOI: 10.1159/000494827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1-2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning -approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.
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Affiliation(s)
- Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands,
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | - Dugan W Maddux
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | | | - Xiaoling Ye
- Renal Research Institute, New York, New York, USA
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Jeong JH, Biruete A, Fernhall B, Wilund KR. Effects of acute intradialytic exercise on cardiovascular responses in hemodialysis patients. Hemodial Int 2018; 22:524-533. [PMID: 29745006 PMCID: PMC10463186 DOI: 10.1111/hdi.12664] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with kidney failure requiring hemodialysis (HD) treatment, intradialytic exercise (IDEX) has been advocated for its feasibility and effectiveness in improving important health outcomes. However, IDEX as an adjunct therapeutic strategy is infrequently implemented, in part due to potential risks of IDEX, especially in patients with chronic volume overload. This study was performed to evaluate the safety of IDEX performed at different time points by examining its effect on intradialytic cardiovascular hemodynamics. METHODS In a randomized cross-over study (n = 12), intradialytic changes in brachial, aortic, and cardiac hemodynamics and autonomic function were examined during a HD session; (1) without exercise; (2) with 30 min of IDEX performed in the first hour of treatment; or (3) with 30 min of IDEX in the third hour of treatment. RESULTS IDEX during either the first or third hour did not exacerbate hemodynamic instability during treatment regardless of patient's hydrations status. While there were transient increases in stroke volume, cardiac output, and heart rate during IDEX, intradialytic changes in brachial and aortic blood pressure, cardiac hemodynamics, and autonomic function were similar on days with and without IDEX. CONCLUSION These results indicate that IDEX does not exacerbate hemodynamic instability during HD, regardless of a patient's hydration status or the timing of exercise.
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Affiliation(s)
- Jin Hee Jeong
- Department of Kinesiology and Community Health, Urbana, Illinois, USA
| | - Annabel Biruete
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, Urbana, Illinois, USA
| | - Bo Fernhall
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, Urbana, Illinois, USA
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Impact of intradialytic blood pressure changes on cardiovascular outcomes is independent of the volume status of maintenance hemodialysis patients. ACTA ACUST UNITED AC 2018; 12:779-788. [PMID: 30031744 DOI: 10.1016/j.jash.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/02/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022]
Abstract
Intradialytic systolic blood pressure (SBP) changes are related to the volume status; however, whether SBP change impacts on adverse outcomes depends on the volume status remains uncertain. We retrospectively investigated the relationship among intradialytic changes in SBP, cardiovascular outcomes, and volume status in maintenance hemodialysis patients. We determined SBP changes (ΔSBP) as postdialysis SBP minus predialysis SBP and volume status as the ratio of extracellular water to total body water (ECW/TBW) using bioelectrical impedance analysis. There were 82 (60.3%) with ΔSBP -20 to 10 mm Hg, 21 (15.4%) with ΔSBP ≤ -20 mm Hg, and 33 (24.3%) with ΔSBP ≥ 10 mm Hg, and they were followed up for a median of 34 months. Cardiovascular events more frequently occurred in the patients with ΔSBP ≤ -20 mm Hg and ≥ 10 mm Hg (hazard ratio: 2.3 and 3.0; P = .062 and .006); these associations persisted even after adjusting for postdialysis ECW/TBW (P = .056 and .028). Moreover, ΔSBP ≥ 10 mm Hg was associated with increased cardiovascular mortalities independent of postdialysis ECW/TBW (P = .043). There was an independent association of volume status between considerable SBP decrease or increase during hemodialysis and adverse cardiovascular outcomes. Besides appropriate volume control, other factors related to BP changes during hemodialysis must be investigated.
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The Association between Intradialytic Hypertension and Metabolic Disorders in End Stage Renal Disease. Int J Hypertens 2018. [PMID: 29850223 DOI: 10.1155/2018/1681056.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Intradialytic hypertension was associated with a high mortality risk. We examined the relationship between intradialytic hypertension and metabolic disorders in hemodialysis treatment patients. Methods We studied 76 patients in online hemodiafiltration. Dialysis adequacy was defined by Kt/V for urea. Normalized protein catabolic rate (nPCR), as a marker of protein intake, was calculated. Sodium removal was determined as percent sodium removal. Metabolic acidosis was determined by serum bicarbonate less than 22 mmol/L. Interdialytic urine volume more than 100 ml was recorded. Intradialytic hypertension was defined by an increase in systolic blood pressure equal to 10 mmHg from pre- to posthemodialysis. Arterial stiffness was assessed as carotid-femoral pulse wave velocity (c-fPWV) and carotid augmentation index (AIx). Chi-square tests and logistic regression analysis were applied for intradialytic hypertension prediction. Results Patients with intradialytic hypertension were older and had significantly lower hemoglobin, nPCR, urine output, and serum bicarbonate and significantly higher c-fPWV, though similar Kt/V for urea, than patients without intradialytic hypertension. They also had increased sodium removal and pulse pressure related to less urine output. Serum bicarbonate was inversely associated with c-fPWV (r = -0.377, p = 0.001). Chi-square test showed significant association between intradialytic hypertension and serum bicarbonate < 22 mmol/L (x2 = 5.6, p = 0.01), which was supported by an adjusted model. Conclusion The intradialytic hypertension was significantly associated with metabolic disorders including malnutrition/inflammation and uncontrolled metabolic acidosis in hemodialysis treatment patients. Severe metabolic acidosis may reflect sodium imbalance and hemodynamic instability of these patients resulting in volume overload and increased vascular resistance.
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Wang F, Zhou JY, Tian Y, Wang Y, Zhang P, Chen JH, Li JS. Intradialytic blood pressure pattern recognition based on density peak clustering. J Biomed Inform 2018; 83:33-39. [PMID: 29793070 DOI: 10.1016/j.jbi.2018.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/15/2018] [Accepted: 05/20/2018] [Indexed: 10/16/2022]
Abstract
End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD) and requires hemodialysis (HD) for survival. Intradialytic blood pressure (IBP) measurements are necessary to ensure patient safety during HD treatments and have critical clinical and prognostic significance. Studies on IBP measurements, especially IBP patterns, are limited. All related studies have been based on a priori knowledge and artificially classified IBP patterns. Therefore, the results were influenced by subjective concepts. In this study, we proposed a new approach to identify IBP patterns to classify ESRD patients. We used the dynamic time warping (DTW) algorithm to measure the similarity between two series of IBP data. Five blood pressure (BP) patterns were identified by applying the density peak clustering algorithm (DPCA) to the IBP data. To illustrate the association between BP patterns and prognosis, we constructed three random survival forest (RSF) models with different covariates. Model accuracy was improved 3.7-6.3% by the inclusion of BP patterns. The results suggest that BP patterns have critical clinical and prognostic significance regarding the risk of cerebrovascular events. We can also apply this clustering approach to other time series data from electronic health records (EHRs). This work is generalizable to analyses of dense EHR data.
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Affiliation(s)
- Feng Wang
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jing-Yi Zhou
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Yu Tian
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yu Wang
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ping Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Jiang-Hua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, China
| | - Jing-Song Li
- Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
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Tsai MY, Wu CH, Huang YC, Chen SY, Ng HY, Su YJ, Chen YH. Treatment of intradialytic hypotension with an herbal acupoint therapy in hemodialysis patients: A randomized pilot study. Complement Ther Med 2018; 38:67-73. [PMID: 29857882 DOI: 10.1016/j.ctim.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/14/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Hypotension during hemodialysis (HD) is the most common complication that negatively affects the quality of life of patients. The objective of the current study was to evaluate the preliminary efficacy and safety of herbal acupoint therapy (HAT) for intradialytic hypotension (IDH). METHODS A randomized, placebo-controlled trial was performed in 32 HD patients to determine whether HAT was more effective than a sham treatment for the treatment of IDH. The outcomes were frequency of IDH episodes and number of nursing interventions during HD sessions, pre- and post-dialysis BP, subjective change in fatigue as measured by the Visual Analogue Scale (VAS), and recovery time from fatigue after dialysis at the 0th and 4th week. Data analyses were performed using per-protocol population. RESULTS In all, 27 patients (84%) completed the entire study. At the end of the intervention, the patients in the HAT group were found to have a significantly lower frequency of IDH episodes, fewer nursing interventions, a lower intervention failure rate, and earlier discontinuation of dialysis than those in the sham group (p < .05). The improvement in degree of fatigue (p = .001) was greater and recovery time from fatigue after dialysis (p = .03) was shorter in the group treated with HAT than in the sham group. HAT was safe, with 2 withdrawal cases due to local erythema caused by the patch. CONCLUSIONS HAT appears to be safe and efficacious for improving IDH-related symptoms and intervention in HD patients. Larger studies are needed to confirm the benefit of this technique for IDH.
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Affiliation(s)
- Ming-Yen Tsai
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Chinese Medicine Research Center, Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, 40402, Taiwan; Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan.
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Yu-Chuen Huang
- Department of Medical Research, China Medical University Hospital and School of Chinese Medicine, China Medical University, Taichung, 41354, Taiwan
| | - Shih-Yu Chen
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Hwee-Yeong Ng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Yu-Jen Su
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Chinese Medicine Research Center, Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, 40402, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, 41354, Taiwan.
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Abstract
PURPOSE OF REVIEW Intradialytic hypertension occurs regularly in 10--15% of hemodialysis patients. A large observational study recently showed that intradialytic hypertension of any magnitude increased mortality risk comparable to the most severe degrees of intradialytic hypotension. The present review review discusses the most recent evidence underlying the pathophysiology of intradialytic hypertension and implications for its management. RECENT FINDINGS Patients with intradialytic hypertension typically have small interdialytic weight gains, but bioimpedance spectroscopy shows these patients have significant chronic extracellular volume excess. Intradialytic hypertension patients have lower albumin and predialysis urea nitrogen levels, which may contribute to small reductions in osmolarity that prevents blood pressure decreases. Intradialytic vascular resistance surges remain implicated as the driving force for blood pressure increases, but mediators other than endothelin-1 may be responsible. Beyond dry weight reduction, the only controlled intervention shown to interrupt the blood pressure increase is lowering dialysate sodium. SUMMARY Patients with recurrent intradialytic hypertension should be identified as high-risk patients. Dry weight should be re-evaluated, even if patients do not clinically appear volume overloaded. Antihypertensive drugs should be prescribed because of the persistently elevated ambulatory blood pressure. Dialysate sodium reduction should be considered, although the long term effects of this intervention are uncertain.
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Assimon MM, Wang L, Flythe JE. Intradialytic Hypertension Frequency and Short-Term Clinical Outcomes Among Individuals Receiving Maintenance Hemodialysis. Am J Hypertens 2018; 31:329-339. [PMID: 29077786 DOI: 10.1093/ajh/hpx186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/12/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Intradialytic hypertension occurs in 5-20% of hemodialysis treatments. Observational data support an association between intradialytic hypertension and long-term mortality. However, the short-term consequences of recurrent intradialytic hypertension are unknown. METHODS Data were taken from a cohort of prevalent hemodialysis patients receiving treatment at a large United States dialysis organization on 1 January 2010. A retrospective cohort design with a 180-day baseline, 30-day exposure assessment, and 30-day follow-up period was used to estimate the associations between intradialytic hypertension frequency and 30-day outcomes. Intradialytic hypertension frequency was defined as the proportion of exposure period hemodialysis treatments with a predialysis to postdialysis systolic blood pressure rise >0 mm Hg. Multivariable Cox proportional hazards regression, adjusted for baseline clinical, laboratory, and dialysis treatment covariates, was used to estimate hazard ratios and 95% confidence intervals. RESULTS Of the 37,094 study patients, 5,242 (14.1%), 17,965 (48.4%), 10,821 (29.2%), 3,066 (8.3%) had intradialytic hypertension in 0%, 1-32%, 33-66%, and ≥67% of exposure period treatments, respectively. More frequent intradialytic hypertension was associated with incremental increases in 30-day mortality and hospitalizations. Patients with intradialytic hypertension in ≥67% (vs. 0%) of exposure period treatments had the highest risk of all-cause death, hazard ratio [95% confidence interval]: 2.57 [1.68, 3.94]; cardiovascular (CV) death, 3.68 [1.89, 7.15]; all-cause hospitalizations, 1.42 [1.26, 1.62]; CV hospitalizations, 1.71 [1.36, 2.15]; and volume-related hospitalizations, 2.25 [1.25, 4.04]. CONCLUSIONS Among prevalent hemodialysis patients, more frequent intradialytic hypertension was incrementally associated with increased 30-day morbidity and mortality. Intradialytic hypertension may be an important short-term risk marker in the hemodialysis population.
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Affiliation(s)
- Magdalene M Assimon
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lily Wang
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer E Flythe
- University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
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