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Implementation of an Algorithm Utilizing Saline Versus Albumin for the Treatment of Intradialytic Hypotension.
Ann Pharmacother. 2019 02; 53(2):159-164.AP

Abstract

BACKGROUND

Intradialytic hypotension (IDH) is the most commonly reported complication of hemodialysis (HD) treatment. At our institution, dialysis patients often have both 25% albumin and normal saline ordered as rescue options for management of IDH, without specification of which agent to use first.

OBJECTIVE

The purpose of this study was to determine the effect of an algorithm for IDH management.

METHODS

A retrospective study was conducted in HD patients who experienced IDH. The primary end point was to evaluate albumin use. Secondary end points included albumin costs, study fluid use per dialysis session, compliance with algorithm, efficacy of hypotension reversal to mean arterial pressure (MAP) ⩾60 mm Hg, percentage of target ultrafiltration achieved, time required to restore systolic blood pressure ⩾90 mm Hg, blood pressure post-study fluids, IDH treatment failure rate, and early termination of dialysis as a result of persistent IDH.

RESULTS

Implementation of the algorithm was observed in 94% of patients (n = 90). Total albumin use was significantly reduced from 11 400 to 4700 mL in the pre- (n = 90) and post-algorithm implementation group (n = 90; P < 0.001). The associated total cost of albumin was reduced by 59% ($10 534 vs $4343; P < 0.001). No statistical differences were observed between the 2 groups regarding efficacy of hypotension reversal to MAP ⩾60 mm Hg, early HD termination, or treatment failure rates (all P = 0.99). Conclusion and Relevance: Implementation of an evidence-based, standardized algorithm and pharmacy education to nursing staff can result in a reduction in albumin use and its associated drug costs for IDH management without compromising efficacy of IDH reversal.

Authors+Show Affiliations

1 Florida Hospital Orlando, FL, USA.1 Florida Hospital Orlando, FL, USA.1 Florida Hospital Orlando, FL, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30221974

Citation

Yin, Ling, et al. "Implementation of an Algorithm Utilizing Saline Versus Albumin for the Treatment of Intradialytic Hypotension." The Annals of Pharmacotherapy, vol. 53, no. 2, 2019, pp. 159-164.
Yin L, Dubovetsky D, Louzon-Lynch P. Implementation of an Algorithm Utilizing Saline Versus Albumin for the Treatment of Intradialytic Hypotension. Ann Pharmacother. 2019;53(2):159-164.
Yin, L., Dubovetsky, D., & Louzon-Lynch, P. (2019). Implementation of an Algorithm Utilizing Saline Versus Albumin for the Treatment of Intradialytic Hypotension. The Annals of Pharmacotherapy, 53(2), 159-164. https://doi.org/10.1177/1060028018801024
Yin L, Dubovetsky D, Louzon-Lynch P. Implementation of an Algorithm Utilizing Saline Versus Albumin for the Treatment of Intradialytic Hypotension. Ann Pharmacother. 2019;53(2):159-164. PubMed PMID: 30221974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of an Algorithm Utilizing Saline Versus Albumin for the Treatment of Intradialytic Hypotension. AU - Yin,Ling, AU - Dubovetsky,Dennis, AU - Louzon-Lynch,Patricia, Y1 - 2018/09/15/ PY - 2018/9/18/pubmed PY - 2018/9/18/medline PY - 2018/9/18/entrez KW - albumin KW - intradialytic hypotension KW - normal saline SP - 159 EP - 164 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 53 IS - 2 N2 - BACKGROUND: Intradialytic hypotension (IDH) is the most commonly reported complication of hemodialysis (HD) treatment. At our institution, dialysis patients often have both 25% albumin and normal saline ordered as rescue options for management of IDH, without specification of which agent to use first. OBJECTIVE: The purpose of this study was to determine the effect of an algorithm for IDH management. METHODS: A retrospective study was conducted in HD patients who experienced IDH. The primary end point was to evaluate albumin use. Secondary end points included albumin costs, study fluid use per dialysis session, compliance with algorithm, efficacy of hypotension reversal to mean arterial pressure (MAP) ⩾60 mm Hg, percentage of target ultrafiltration achieved, time required to restore systolic blood pressure ⩾90 mm Hg, blood pressure post-study fluids, IDH treatment failure rate, and early termination of dialysis as a result of persistent IDH. RESULTS: Implementation of the algorithm was observed in 94% of patients (n = 90). Total albumin use was significantly reduced from 11 400 to 4700 mL in the pre- (n = 90) and post-algorithm implementation group (n = 90; P < 0.001). The associated total cost of albumin was reduced by 59% ($10 534 vs $4343; P < 0.001). No statistical differences were observed between the 2 groups regarding efficacy of hypotension reversal to MAP ⩾60 mm Hg, early HD termination, or treatment failure rates (all P = 0.99). Conclusion and Relevance: Implementation of an evidence-based, standardized algorithm and pharmacy education to nursing staff can result in a reduction in albumin use and its associated drug costs for IDH management without compromising efficacy of IDH reversal. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/30221974/Implementation_of_an_Algorithm_Utilizing_Saline_Versus_Albumin_for_the_Treatment_of_Intradialytic_Hypotension_ L2 - http://journals.sagepub.com/doi/full/10.1177/1060028018801024?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -