Stopping Ultrafiltration Related Blood Pressure Changes in Hemodialysis Patients

Year 2020, Volume: 6 Issue: 3, 281 - 287, 31.12.2020

Ahmet Karataş , Emre Erdem

https://doi.org/10.19127/mbsjohs.804189

Abstract

Objective: The present study inquired the effects of stopping ultrafiltration on arterial pressure in hemodialysis patients.
Methods: Our study was performed in 92 hemodialysis patients. Ultrafiltration was stopped after the 3rd hour of hemodialysis. Arterial pressure was measured in the supine position at 0, 5, and 10 minutes after ultrafiltration was stopped.
Results: Systolic arterial pressure increased by a mean of 4 mm Hg and diastolic arterial pressure increased by a mean of 2 mmHg at 10 minutes after ultrafiltration was stopped. With regard to the difference between mean arterial pressure measured before dialysis and just after stopping ultrafiltration (0. minute), systolic arterial pressure increased by a means of 5 mmHg and diastolic arterial pressure increased by a mean of 2 mmHg at 10 minutes after ultrafiltration was stopped in the patients with a mean arterial pressure decrease of ≥ 10 mmHg. However, stopping ultrafiltration caused no significant changes in the systolic arterial pressure or diastolic arterial pressure of the patients with a mean arterial pressure decrease of < 10 mmHg. An important correlation was determined between systolic arterial pressure elevation after stopping ultrafiltration and age, ultrafiltration rate, duration of hemodialysis, gender in the patients with a mean arterial pressure decrease of ≥ 10 mmHg. Age and gender were the independent variables, which affected the systolic arterial pressure elevation after stopping ultrafiltration.
Conclusion: In patients with a mean arterial pressure decrease of ≥ 10 mmHg, stopping ultrafiltration increases arterial pressure but this is a limited elevation. Stopping ultrafiltration related systolic arterial pressure elevation is more evident in females and in the elderly.

Keywords

blood pressure, hemodialysis, hypotension, ultrafiltration

References

• Abdelfatah AB, Motte G, Ducloux D, Chalopin JM. Determinants of mean arterial pressure and pulse pressure in chronic haemodialysis patients. J Hum Hypertens 2001;15:775-779.
• Akpolat T, Erdem E, Aydogdu T. Validation of the Omron M3 Intellisense (HEM-7051-E) upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol Revision 2010 in a Stage 3–5 chronic kidney disease population. Kidney Blood Press Res 2012;35:82-88.
• Barth C, Boer W, Garzoni D, Kuenzi T, Ries W, Schaefer R, Schneditz D, Tsobanelis T, van der Sande F, Wojke R, Schilling H, Passlick-Deetjen J. Characteristics of hypotension-prone hemodialysis patients:is there a critical relative blood volüme. Nephrol Dial Transplant 2003;18:1353-1360.
• Bradshaw W, Bennett PN. Asymptomatic Intradialytic Hypotension: The Need for Pre-Emptive Intervention. Nephrol Nurs J 2015;42:479-485.
• Bradshaw W, Ockerby C, Bennett P. Pre-emptively pausing ultrafiltration to minimise dialysis hypotension. Ren Soc Aust J 2011;7:130-134. Coll E, Valles M, Torguet P, Bronsoms J, Mate G, Mauri JM. Evaluation of plasma volume variation during different hemodialysis. Nefrologia 2004;24:463-469.
• Erdem E. The effects of passive leg raising and ultrafiltration stopping on blood pressure in hemodialysis patients. Int Urol Nephrol 2016;48:877-882.
• Geerts BF, van den Bergh L, Stijnen T, Aarts LP, Jansen JR. Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia? J Clin Anesth 2012;24:668-674.
• Hox V, Desai A, Bandara G, Gilfillan AM, Metcalfe DD, Olivera A. Estrogen increases the severity of anaphylaxis in female mice through enhanced endothelial nitric oxide synthase expression and nitric oxide production. J Allergy Clin Immunol 2015;135:729-736.
• Jordan J, Shannon JR, Black BK, Ali Y, Farley M, Costa F, Diedrich A, Robertson RM, Biaggioni I, Robertson D. The pressor response to water drinking in humans: a sympathetic reflex? Circulation 2000;101:504-509.
• K/DOQI Workgroup: KDOQI clinical practice guidline for cardiovacular disease in dialysis patients. Am J Kidney Dis 2005;45:1-153.
• Kooman J, Basci A, Pizzarelli F, Canaud B, Haage P, Fouque D, Konner K, Martin-Malo A, Pedrini L, Tattersall J, Tordoir J, Vennegoor M, Wanner C, ter Wee P, Vanholder R. EBPG guideline on haemodynamic instability. Nephrol Dial Transplant 2007;22:22-44.
• Oakley R, Tharakan B. Vascular hyperpermeability and aging. Aging Dis 2014 Apr 1;5(2):114-125.
• Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol 2008;19:8-11.
• Sands JJ, Usvyat LA, Sullivan T, Segal JH, Zabetakis P, Kotanko P, Maddux FW, Diaz-Buxo JA. Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int 2014;18:415-422.
• Santoro A, Mancini E, Zucchelli P. Ultrafiltration behaviour with different dialysis schedules. Nephrol Dial Transplant 1998;13:55-61.
• Saran R, Bragg-Gresham JL, Levin NW, Twardowski ZJ, Wizemann V, Saito A, Kimata N, Gillespie BW, Combe C, Bommer J, Akiba T, Mapes DL, Young EW, Port FK. Longer treatment time and slower ultrafiltration in hemodialysis: Associations with reduced mortality in the DOPPS. Kidney Int 2006;69:1222-1228.
• Schneditz D, Roob J, Oswald M, Pogglitsch H, Moser M, Kenner T, Binswanger U. Nature and rate of vascular refilling during hemodialysis and ultrafiltration. Kidney Int 1992;42:1425-1433.
• Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int 2004;66:1212-1220.
• Sulowicz W, Radziszewki A. Pathogenesis and treatment of dialysis hypotension. Kidney Int 2006;70:36-39.
• Thijssen S, Kappel F, Kotanko P. Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it? Blood Purif 2013;35:63-71.
• Van der Sande FM, Kooman JP, Leunissen KM. Intradialytic hypotension–new concepts on an old problem. Nephrol Dial Transplant 2000;15:1746-174