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Evaluation of intradialytic hypotension using impedance cardiography

  • Nephrology – Original Paper
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Abstract

Background

Hypotension during hemodialysis is frequent in patients with cardiovascular disease who have a limited physiological compensatory response. Recent advances in technology allow non-invasive monitoring of cardiac output and derived hemodynamic parameters. This prospective study evaluated episodes of intradialytic hypotension using clinical data and continuous non-invasive hemodynamic monitoring by impedance cardiography.

Methods

Forty-eight chronic hemodialysis patients, with prevalence for intradialytic hypotensive episodes, underwent evaluation with non-invasive impedance cardiography (Physioflow®) before, during and after a regular dialysis session.

Results

During continuous non-invasive cardiac monitoring, a fall of systolic arterial blood pressure of 20% or more at least once during hemodialysis was detected in 18 patients (37.5%)—thereafter identified as the “Unstable” group. In 30 patients—thereafter called the “Stable” group, the blood pressure did not change significantly. During hypotension, a decrease in cardiac output was found in 11 of the 18 unstable patients, and a significant fall in peripheral resistance in the remaining 7. End-diastolic filling ratio was significantly lower in the unstable group. The most significant predictors associated with intradialytic hypotension were the presence of ischemic heart disease (P = 0.05), and medication with beta blockers (P = 0.037) and calcium channel blockers (P = 0.018).

Conclusions

Hemodynamic changes in dialysis patients with hypotensive episodes included decreased cardiac output or decreased peripheral resistance. A lower end-diastolic filling ratio may be regarded as a marker for reduced preload in these patients. Non-invasive impedance cardiography may be used to evaluate risk factors for hypotension in dialysis patients.

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Authors and Affiliations

  1. Medical Intensive Care Unit, Division of Medicine, Hadassah-University Medical Centre, Ein Kerem, Jerusalem, 91120, Israel

    Abed Bayya, David Michael Linton & Sigal Sviri

  2. Department of Nephrology, Hadassah-University Medical Centre, Ein Kerem, Jerusalem, 91120, Israel

    Dvora Rubinger

Authors
  1. Abed Bayya
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  2. Dvora Rubinger
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  3. David Michael Linton
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  4. Sigal Sviri
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Correspondence to Sigal Sviri.

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Bayya, A., Rubinger, D., Linton, D.M. et al. Evaluation of intradialytic hypotension using impedance cardiography. Int Urol Nephrol 43, 855–864 (2011). https://doi.org/10.1007/s11255-010-9746-3

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  • DOI: https://doi.org/10.1007/s11255-010-9746-3

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