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Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis.
Clin Nephrol. 2006 Jul; 66(1):39-50.CN

Abstract

BACKGROUND

Intradialytic hypotension (IDH) is one of the most severe complications during hemodialysis. Its appearance is caused in part by rapid fluid removal with concomitant failure in blood pressure regulation but also by other dialytic-dependent and independent factors.

PATIENTS AND METHODS

We investigated total (TBW), extracellular (ECW) and intracellular water (ICW) in chronic intermittent hemodialysis dialysis hypotension-prone (CRF-HP, n = 11) and nonhypotension-prone (CRF-NHP, n = 10) patients with end-stage renal disease before, every 30 minutes during, as well as after dialysis and within onset of intradialytic hypotension by multifrequent bioimpedance analysis (BIA). Additionally, intradialytic time course of BIA in patients with acute renal failure (ARF) and septic shock (n = 10) was observed.

RESULTS

IDH occurred in 72.1% of CRF-HP and in 80% of ARF patients. In CRF-HP and CRF-NHP, ECW significantly decreased by -12.44 +/- 4.22% in CRF-HP and -9.0 +/- 6.2% in CRF-NHP comparing pre- and post-dialysis values (each p < 0.01). Conversely, ICW increased by +11.5 +/- 11.3% in CRF-HP and +18.4 +/- 25.2% in CRF-NHP (each p < 0.05). In patients with ARF no significant changes could be detected. Calculated ECW/ICW and ECW/TBW ratio significantly decreased in CRF patients with a higher rate in CRF-HP patients (p < 0.05). Neither ECW/ICW nor ECW/TBW ratio correlated with mean arterial pressure. The onset of intradialytic hypotension (n = 35) did not differ intraindividually compared to normotensive periods (n = 411). Fluid removal in CRF patients seems to be mainly from the extracellular space. The reduced decreases in ECW/ICW and ECW/TBW ratios in CRF-HP compared to CRF-NHP may indicate an insufficient refilling from intra- to extracellular compartment in CRF-HP.

CONCLUSION

In conclusion, multifrequent BIA is not capable to predict hypotension in the individual patient during a particular dialysis session.

Authors+Show Affiliations

Department of Nephrology and Rheumatology, Georg August University Göttingen, Germany. mkoziolek@med.uni-goettingen.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16878434

Citation

Koziolek, M J., et al. "Bioimpedance Analysis and Intradialytic Hypotension in Intermittent Hemodialysis." Clinical Nephrology, vol. 66, no. 1, 2006, pp. 39-50.
Koziolek MJ, Gauczinski S, Kahler E, et al. Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis. Clin Nephrol. 2006;66(1):39-50.
Koziolek, M. J., Gauczinski, S., Kahler, E., Bramlage, C. P., Scheel, A. K., Mueller, G. A., & Strutz, F. (2006). Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis. Clinical Nephrology, 66(1), 39-50.
Koziolek MJ, et al. Bioimpedance Analysis and Intradialytic Hypotension in Intermittent Hemodialysis. Clin Nephrol. 2006;66(1):39-50. PubMed PMID: 16878434.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bioimpedance analysis and intradialytic hypotension in intermittent hemodialysis. AU - Koziolek,M J, AU - Gauczinski,S, AU - Kahler,E, AU - Bramlage,C P, AU - Scheel,A K, AU - Mueller,G A, AU - Strutz,F, PY - 2006/8/2/pubmed PY - 2006/12/9/medline PY - 2006/8/2/entrez SP - 39 EP - 50 JF - Clinical nephrology JO - Clin. Nephrol. VL - 66 IS - 1 N2 - BACKGROUND: Intradialytic hypotension (IDH) is one of the most severe complications during hemodialysis. Its appearance is caused in part by rapid fluid removal with concomitant failure in blood pressure regulation but also by other dialytic-dependent and independent factors. PATIENTS AND METHODS: We investigated total (TBW), extracellular (ECW) and intracellular water (ICW) in chronic intermittent hemodialysis dialysis hypotension-prone (CRF-HP, n = 11) and nonhypotension-prone (CRF-NHP, n = 10) patients with end-stage renal disease before, every 30 minutes during, as well as after dialysis and within onset of intradialytic hypotension by multifrequent bioimpedance analysis (BIA). Additionally, intradialytic time course of BIA in patients with acute renal failure (ARF) and septic shock (n = 10) was observed. RESULTS: IDH occurred in 72.1% of CRF-HP and in 80% of ARF patients. In CRF-HP and CRF-NHP, ECW significantly decreased by -12.44 +/- 4.22% in CRF-HP and -9.0 +/- 6.2% in CRF-NHP comparing pre- and post-dialysis values (each p < 0.01). Conversely, ICW increased by +11.5 +/- 11.3% in CRF-HP and +18.4 +/- 25.2% in CRF-NHP (each p < 0.05). In patients with ARF no significant changes could be detected. Calculated ECW/ICW and ECW/TBW ratio significantly decreased in CRF patients with a higher rate in CRF-HP patients (p < 0.05). Neither ECW/ICW nor ECW/TBW ratio correlated with mean arterial pressure. The onset of intradialytic hypotension (n = 35) did not differ intraindividually compared to normotensive periods (n = 411). Fluid removal in CRF patients seems to be mainly from the extracellular space. The reduced decreases in ECW/ICW and ECW/TBW ratios in CRF-HP compared to CRF-NHP may indicate an insufficient refilling from intra- to extracellular compartment in CRF-HP. CONCLUSION: In conclusion, multifrequent BIA is not capable to predict hypotension in the individual patient during a particular dialysis session. SN - 0301-0430 UR - https://www.unboundmedicine.com/medline/citation/16878434/Bioimpedance_analysis_and_intradialytic_hypotension_in_intermittent_hemodialysis_ L2 - https://medlineplus.gov/lowbloodpressure.html DB - PRIME DP - Unbound Medicine ER -