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Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial.
Kidney Int. 2002 Sep; 62(3):1034-45.KI

Abstract

BACKGROUND

Recently we have devised and tested a biofeedback system for controlling blood volume (BV) changes during hemodialysis (HD) along an ideal trajectory (blood volume tracking, BVT), continuously modifying the weight loss rate and dialysate conductivity. This multicenter, prospective, randomized, crossover study aimed to clarify whether BVT (treatment B) can improve hypotension-prone patients' treatment tolerance, compared with conventional hemodialysis (treatment A).

METHODS

Thirty-six hypotension-prone patients enrolled from 10 hemodialysis (HD) centers were randomly assigned to either of the study sequences ABAB or BABA, each lasting four months.

RESULTS

A 30% reduction in intradialytic hypotension (IDH) events was observed in treatment B as compared with A (23.5% vs. 33.5%, P = 0.004). The reduction was related to the number of IDH in treatment A (y = 0.54x + 5; r = 0.4; P < 0.001): the more IDH episodes in treatment A, the better the response in treatment B. The best responders to treatment B showed pre-dialysis systolic blood pressure values higher than the poor responders (P = 0.04). A 10% overall reduction in inter-dialysis symptoms was obtained also in treatment B compared to A (P < 0.001). Body weight gain, pre-dialysis blood pressure, intradialytic weight loss as well as Kt/V did not differ between the two treatments.

CONCLUSIONS

An overall improvement in the treatment tolerance was observed with BVT, particularly intradialytic cardiovascular stability. Patients with the highest incidence of IDH during conventional HD and free from chronic pre-dialysis hypotension seem to respond better. Inter-dialysis symptoms also seem to improve with control of BV.

Authors+Show Affiliations

Divisione de Nefrologia e Dialisi Malpighi, Policlinico S. Orsola-Malpighi, Via P. Palagi 9, 40138 Bologna, Italy. santoro@orsola-malpighi.med.unibo.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

12164888

Citation

Santoro, Antonio, et al. "Blood Volume Controlled Hemodialysis in Hypotension-prone Patients: a Randomized, Multicenter Controlled Trial." Kidney International, vol. 62, no. 3, 2002, pp. 1034-45.
Santoro A, Mancini E, Basile C, et al. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int. 2002;62(3):1034-45.
Santoro, A., Mancini, E., Basile, C., Amoroso, L., Di Giulio, S., Usberti, M., Colasanti, G., Verzetti, G., Rocco, A., Imbasciati, E., Panzetta, G., Bolzani, R., Grandi, F., & Polacchini, M. (2002). Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney International, 62(3), 1034-45.
Santoro A, et al. Blood Volume Controlled Hemodialysis in Hypotension-prone Patients: a Randomized, Multicenter Controlled Trial. Kidney Int. 2002;62(3):1034-45. PubMed PMID: 12164888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. AU - Santoro,Antonio, AU - Mancini,Elena, AU - Basile,Carlo, AU - Amoroso,Luigi, AU - Di Giulio,Salvatore, AU - Usberti,Mario, AU - Colasanti,Giuliano, AU - Verzetti,Giuseppe, AU - Rocco,Alessandro, AU - Imbasciati,Enrico, AU - Panzetta,Giovanni, AU - Bolzani,Roberto, AU - Grandi,Fabio, AU - Polacchini,Maurizio, PY - 2002/8/8/pubmed PY - 2003/2/13/medline PY - 2002/8/8/entrez SP - 1034 EP - 45 JF - Kidney international JO - Kidney Int VL - 62 IS - 3 N2 - BACKGROUND: Recently we have devised and tested a biofeedback system for controlling blood volume (BV) changes during hemodialysis (HD) along an ideal trajectory (blood volume tracking, BVT), continuously modifying the weight loss rate and dialysate conductivity. This multicenter, prospective, randomized, crossover study aimed to clarify whether BVT (treatment B) can improve hypotension-prone patients' treatment tolerance, compared with conventional hemodialysis (treatment A). METHODS: Thirty-six hypotension-prone patients enrolled from 10 hemodialysis (HD) centers were randomly assigned to either of the study sequences ABAB or BABA, each lasting four months. RESULTS: A 30% reduction in intradialytic hypotension (IDH) events was observed in treatment B as compared with A (23.5% vs. 33.5%, P = 0.004). The reduction was related to the number of IDH in treatment A (y = 0.54x + 5; r = 0.4; P < 0.001): the more IDH episodes in treatment A, the better the response in treatment B. The best responders to treatment B showed pre-dialysis systolic blood pressure values higher than the poor responders (P = 0.04). A 10% overall reduction in inter-dialysis symptoms was obtained also in treatment B compared to A (P < 0.001). Body weight gain, pre-dialysis blood pressure, intradialytic weight loss as well as Kt/V did not differ between the two treatments. CONCLUSIONS: An overall improvement in the treatment tolerance was observed with BVT, particularly intradialytic cardiovascular stability. Patients with the highest incidence of IDH during conventional HD and free from chronic pre-dialysis hypotension seem to respond better. Inter-dialysis symptoms also seem to improve with control of BV. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/12164888/Blood_volume_controlled_hemodialysis_in_hypotension_prone_patients:_a_randomized_multicenter_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)48641-7 DB - PRIME DP - Unbound Medicine ER -