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Intradialytic hypotension prevalence, influencing factors, and nursing interventions: prospective results of 744 hemodialysis sessions

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Abstract

Introduction

The aim of this study was to evaluate intradialytic hypotension (IDH) prevalence, influencing factors, and nursing interventions in hemodialysis (HD) patients.

Methods

This descriptive and cross-sectional study was conducted at a private dialysis center. The patients were followed-up in terms of IDH development based on the European Best Practice Guidelines criteria during six consecutive HD sessions. The study followed the STROBE checklist.

Results

A total of 744 hemodialysis sessions of 124 patients were monitored. IDH developed in 51.6% of the patients and the prevalence was 17.60%. The most common nursing interventions were stopping ultrafiltration and isotonic saline solution administration. White blood cell (WBC) (p = 0.017) and creatinine (p = 0.005) values were statistically significantly higher in patients developing IDH. WBC was found to increase IDH development risk 0.796 times (95% CI [0.657–0.996], p = 0.021).

Conclusion

Nursing staff awareness regarding the frequency of IDH in hemodialysis patients and the related symptoms needs to be increased.

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References

  1. Chou JA, Kalantar-Zadeh K, Mathew AT (2017) A brief review of intradialytic hypotension with a focus on survival. Semin Dial 30(6):473–480. https://doi.org/10.1111/sdi.12627

    Article  PubMed  PubMed Central  Google Scholar 

  2. Stefánsson BV, Brunelli SM, Cabrera C et al (2014) Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol 9(12):2124–2132. https://doi.org/10.2215/CJN.02680314

    Article  PubMed  PubMed Central  Google Scholar 

  3. McIntyre CW, Goldsmith DJ (2015) Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension? Kidney Int 87(6):1109–1115. https://doi.org/10.1038/ki.2015.62

    Article  PubMed  Google Scholar 

  4. Flythe JE, Xue H, Lynch KE et al (2015) Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol 26(3):724–734. https://doi.org/10.1681/ASN.2014020222

    Article  CAS  PubMed  Google Scholar 

  5. Sands JJ, Usvyat LA, Sullivan T et al (2014) Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int 18(2):415–422. https://doi.org/10.1111/hdi.12138

    Article  PubMed  Google Scholar 

  6. Sangala N, Gangaram V, Atkins K et al (2017) Intra-dialytic hypotension: identifying patients most at risk. J Ren Care 43(2):92–97. https://doi.org/10.1111/hdi.12138

    Article  PubMed  Google Scholar 

  7. Chao CT, Huang JW, Yen CJ (2015) Intradialytic hypotension and cardiac remodeling: a vicious cycle. Biomed Res Int 2015:724147–724147. https://doi.org/10.1155/2015/724147

    Article  PubMed  PubMed Central  Google Scholar 

  8. Daugirdas JT (2015) Measuring intradialytic hypotension to improve quality of care. J Am Soc Nephrol 26(3):512–514. https://doi.org/10.1681/ASN.2014090860

    Article  PubMed  Google Scholar 

  9. Barth C, Boer W, Garzoni D et al (2003) Characteristics of hypotension-prone haemodialysis patients: is there a critical relative blood volume? Nephrol Dial Transplant 18(7):1353–1360. https://doi.org/10.1093/ndt/gfg171

    Article  PubMed  Google Scholar 

  10. Jefferies HJ, Burton JO, McIntyre CW (2011) Individualised dialysate temperature improves intradialytic haemodynamics and abrogates haemodialysis induced myocardial stunning, without compromising tolerability. Blood Purif 32(1):63–68. https://doi.org/10.1159/000324199

    Article  PubMed  Google Scholar 

  11. Tuna S, Çınar Pakyüz S, Dedeli Çaydam Ö (2015) Systematic review: prevention of hypotension occurred in hemodialysis. J Nephrol Nurs 102(2):63–79

    Google Scholar 

  12. Beladi Mousavi SS, Tamadon MR (2014) Vasopressin and prevention of hypotension during hemodialysis. Iran Red Crescent Med J 16(11):e20219. https://doi.org/10.5812/ircmj.20219

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kesik G, Özdemir L (2020) Examination of the effects of nursing interventions on intradialytic hypotension. Turk J Nephrol 29(1):33–38. https://doi.org/10.5152/turkjnephrol.2020.3643

    Article  Google Scholar 

  14. Kuipers J, Oosterhuis JK, Krijnen WP et al (2016) Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions-a three-months, prospective study of 3818 haemodialysis sessions. BMC Nephrol 17:21. https://doi.org/10.1186/s12882-016-0231-9

    Article  PubMed  PubMed Central  Google Scholar 

  15. Okoye OC, Slater HE, Rajora N (2017) Prevalence and risk factors of intra-dialytic hypotension: a 5-year retrospective report from a single Nigerian Centre. Pan Afr Med J 28:62. https://doi.org/10.11604/pamj.2017.28.62.13743

    Article  PubMed  PubMed Central  Google Scholar 

  16. Albayrak Cosar A, Cinar S (2009) Effect of dialysate sodium profiling and gradient ultrafiltration on hypotension. Dial Transplant 38(5):1–5. https://doi.org/10.1002/dat.20295

    Article  Google Scholar 

  17. Altıntepe L, Tonbul HZ, Yeksan M, Türk S (2003) Effectivity of different sodium and ultrafiltration profiles on hemodialysis-induced hypotension. J Turk Soc Nephrol 12(1):29–33

    Google Scholar 

  18. Bossola M, Laudisio A, Antocicco M et al (2013) Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis. Ren Fail 35(9):1260–1263. https://doi.org/10.3109/0886022X.820645

    Article  PubMed  Google Scholar 

  19. Salant P, Dillman DA (1994) How to conduct your own survey. John Wiley & Sons, New York

    Google Scholar 

  20. van der Sande FM, Dekker MJ, Leunissen KML, Kooman JP (2018) Novel insights into the pathogenesis and prevention of intradialytic hypotension. Blood Purif 45(1-3):230–235. https://doi.org/10.1159/000485160

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kooman J, Basci A, Pizzarelli F et al (2007) EBPG guideline on haemodynamic instability. Nephrol Dial Transplant 22(Suppl 2):ii22–ii44. https://doi.org/10.1093/ndt/gfm019

    Article  PubMed  Google Scholar 

  22. Meredith DJ, Pugh CW, Sutherland S et al (2015) The relationship between symptoms and blood pressure during maintenance hemodialysis. Hemodial Int 19(4):543–552. https://doi.org/10.1111/hdi.12306

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wanic-Kossowska M, Czekalski S (2007) Hypotension in renal failure patients undergoing dialysis therapy. Pol Arch Intern Med 117(4):178–183

    Article  Google Scholar 

  24. El-Sheikh AA, Abed elsatar OMA (2017) Effect of nursing intervention on prevention of intradialytic hypotension among hemodialysis patients. J Nurs Health Sci 6(5):87–95. https://doi.org/10.9790/1959-0605038795

    Article  Google Scholar 

  25. Park J, Rhee CM, Sim JJ et al (2013) A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival. Kidney Int 84(4):795–802. https://doi.org/10.1038/ki.2013.237

    Article  PubMed  PubMed Central  Google Scholar 

  26. Park S, Kim WJ, Cho NJ et al (2019) Predicting intradialytic hypotension using heart rate variability. Sci Rep 9(1):2574. https://doi.org/10.1038/s41598-019-39295-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Pertosa G, Grandaliano G, Gesualdo L, Schena FP (2000) Clinical relevance of cytokine production in hemodialysis. Kidney Int Suppl 76:S104–S111

    Article  CAS  Google Scholar 

  28. Yokokawa K, Mankus R, Saklayen MG et al (1995) Increased nitric oxide production in patients with hypotension during hemodialysis. Ann Intern Med 123(1):35–37. https://doi.org/10.7326/0003-4819-123-1-199507010-00005

    Article  CAS  PubMed  Google Scholar 

  29. Yokokawa K, Kohno M, Yoshkawa J (1996) Nitric oxide mediates the cardiovascular instability of hemodialysis patients. Curr Opin Nephrol Hypertens 5(4):359–363

    Article  CAS  Google Scholar 

  30. Al-Etreby EA, El-Aziz AA, El-Waseef O, El-Moselhy EA (2016) The association between hypoalbuminemia and intradialytic hypotension in heamodialysis patients. Egypt J Hosp Med 63:185–194

    Article  Google Scholar 

  31. Kora M, Tawfeek A, El-Zorkany K, AbdEl-Mohsen AH (2018) The relationship between hypoalbuminemia and intradialytic hypotension in haemodialysis patients. J Kidney 4(1):165. https://doi.org/10.4172/2472-1220.1000165

    Article  Google Scholar 

  32. Pakfetrat M, Roozbeh Shahroodi J, Malekmakan L et al (2010) Is there an association between intradialytic hypotension and serum magnesium changes? Hemodial Int 14(4):492–497. https://doi.org/10.1111/j.1542-4758.2010.00477.x

    Article  PubMed  Google Scholar 

  33. Ilic LM, Davis RB, Brown RS, Lecker SH (2018) The interdialytic creatinine rise is a novel marker of volume overload and mortality risk in hemodialysis patients. BMC Nephrol 19(1):202. https://doi.org/10.1186/s12882-018-1008-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We would like to thank the patients who participated in the study.

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Authors and Affiliations

  1. Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey

    Nurten Ozen

  2. Private Esenyurt Dialysis Center, Istanbul, Turkey

    Tugba Cepken

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  1. Nurten Ozen
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  2. Tugba Cepken
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Correspondence to Nurten Ozen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ozen, N., Cepken, T. Intradialytic hypotension prevalence, influencing factors, and nursing interventions: prospective results of 744 hemodialysis sessions. Ir J Med Sci 189, 1471–1476 (2020). https://doi.org/10.1007/s11845-020-02249-9

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  • DOI: https://doi.org/10.1007/s11845-020-02249-9

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