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Hemodynamic effects of intradialytic food ingestion and the effects of caffeine.
J Am Soc Nephrol. 1993 May; 3(11):1813-8.JA

Abstract

Although the hypotensive effects of food ingestion during hemodialysis have been documented, the hemodynamic mechanism is unclear. It could be decreased cardiac output due to splanchnic sequestration or decreased vascular resistance due to splanchnic vasorelaxation. Also, the effects of caffeine, which block postprandial hypotension in the elderly, have not been studied in a dialysis setting. Central hemodynamics were monitored by thoracic electric bioimpedance in 10 dialysis patients who ingested a test meal 1 h into dialysis. All ultrafiltration was done during the initial 2 h. Bicarbonate dialysate was used. Each patient was studied three times in a double-blind (with respect to placebo/caffeine) cross-over trial: placebo/no meal, placebo/meal, and caffeine/meal. Blood pressure decreased sooner and to a great extent in the treatments in which food ingestion accompanied ultrafiltration (e.g., at 30 min after food ingestion, percent change in mean arterial pressure was -12.4 +/- 1.8 versus -2.4 +/- 3.5 mm Hg when food was not ingested; P < 0.05). The hemodynamic mechanism of food-associated hypotension was found to be a fall in systemic vascular resistance (SVRI). Caffeine pretreatment (200 mg), which resulted in intradialytic plasma caffeine levels of about 4 micrograms/mL at time of food ingestion, had no effect on food-associated reductions in blood pressure or SVRI. The results suggest that food ingestion during dialysis causes hypotension primarily because of decreased SVRI. The effects of food ingestion on mean arterial pressure and SVRI are not attenuated by the ingestion of 200 mg of caffeine 1 h before dialysis.

Authors+Show Affiliations

Loyola University Stritch School of Medicine, Maywood, IL.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

8329676

Citation

Barakat, M M., et al. "Hemodynamic Effects of Intradialytic Food Ingestion and the Effects of Caffeine." Journal of the American Society of Nephrology : JASN, vol. 3, no. 11, 1993, pp. 1813-8.
Barakat MM, Nawab ZM, Yu AW, et al. Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. J Am Soc Nephrol. 1993;3(11):1813-8.
Barakat, M. M., Nawab, Z. M., Yu, A. W., Lau, A. H., Ing, T. S., & Daugirdas, J. T. (1993). Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. Journal of the American Society of Nephrology : JASN, 3(11), 1813-8.
Barakat MM, et al. Hemodynamic Effects of Intradialytic Food Ingestion and the Effects of Caffeine. J Am Soc Nephrol. 1993;3(11):1813-8. PubMed PMID: 8329676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of intradialytic food ingestion and the effects of caffeine. AU - Barakat,M M, AU - Nawab,Z M, AU - Yu,A W, AU - Lau,A H, AU - Ing,T S, AU - Daugirdas,J T, PY - 1993/5/1/pubmed PY - 1993/5/1/medline PY - 1993/5/1/entrez SP - 1813 EP - 8 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 3 IS - 11 N2 - Although the hypotensive effects of food ingestion during hemodialysis have been documented, the hemodynamic mechanism is unclear. It could be decreased cardiac output due to splanchnic sequestration or decreased vascular resistance due to splanchnic vasorelaxation. Also, the effects of caffeine, which block postprandial hypotension in the elderly, have not been studied in a dialysis setting. Central hemodynamics were monitored by thoracic electric bioimpedance in 10 dialysis patients who ingested a test meal 1 h into dialysis. All ultrafiltration was done during the initial 2 h. Bicarbonate dialysate was used. Each patient was studied three times in a double-blind (with respect to placebo/caffeine) cross-over trial: placebo/no meal, placebo/meal, and caffeine/meal. Blood pressure decreased sooner and to a great extent in the treatments in which food ingestion accompanied ultrafiltration (e.g., at 30 min after food ingestion, percent change in mean arterial pressure was -12.4 +/- 1.8 versus -2.4 +/- 3.5 mm Hg when food was not ingested; P < 0.05). The hemodynamic mechanism of food-associated hypotension was found to be a fall in systemic vascular resistance (SVRI). Caffeine pretreatment (200 mg), which resulted in intradialytic plasma caffeine levels of about 4 micrograms/mL at time of food ingestion, had no effect on food-associated reductions in blood pressure or SVRI. The results suggest that food ingestion during dialysis causes hypotension primarily because of decreased SVRI. The effects of food ingestion on mean arterial pressure and SVRI are not attenuated by the ingestion of 200 mg of caffeine 1 h before dialysis. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/8329676/Hemodynamic_effects_of_intradialytic_food_ingestion_and_the_effects_of_caffeine_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=8329676 DB - PRIME DP - Unbound Medicine ER -