scholarly journals Changes in extracellular water with hemodialysis and fall in systolic blood pressure

2021 ◽  
pp. 039139882199550
Author(s):  
Kamonwan Tangvoraphonkchai ◽  
Andrew Davenport
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Logistic Model ◽  
Extracellular Volume ◽  
Confidence Limits ◽  
Extracellular Water ◽  
Urea Clearance ◽  
Session Duration ◽  
Dialysis Vintage ◽  
Dialysate Sodium

Introduction: Intra-dialytic hypotension (IDH) remains the most common complication with outpatient hemodialysis (HD) sessions. As fluid is removed during HD, there is contraction of the extracellular volume (ECW). We wished to determine whether the fall in ECW was associated with a fall in systolic blood pressure (SBP). Methods: We retrospectively reviewed the records of adult dialysis outpatients attending for their midweek sessions who had corresponding pre- and post-HD bioimpedance measurements of ECW. Result: We reviewed 736 patients, median age 67 (54–76) years, 62.8% male, 45.7% diabetic with a median dialysis vintage of 24.4 (9.2–56.8) months. The percentage fall in ECW (ECW%) was associated with post-dialysis systolic blood pressure (SBP) ( r = −0.14, p < 0.001). Patients with SBP falls of >20 mmHg had a greater fall in ECW% compared to patients with stable SBP 7.6 (4.6–10.1) vs 6.0 (4.0–8.5), p < 0.001). Patients with greater dialyzer urea clearance had greater fall in ECW% ( r = 0.19, p < 0.001). In a logistic model an increased fall in ECW% was associated with weight loss (odds ratio (OR) 1.88, 95% confidence limits (CL) 1.62–2.176, p < 0.001), and session duration (OR 1.45 (CL 1.05–1.99), p = 0.024), and negatively with hemodiafiltration compared to hemodialysis (OR 0.37 (0.19–0.74) p = 0.005 and dialysate sodium to plasma gradient (OR 0.95 (CL 0.90–0.99), p = 0.021). Conclusion: We observed an association between the reduction in ECW and SBP with dialysis. Our results would advocate monitoring ECW changes during dialysis and developing biofeedback devices to control ultrafiltration and dialysate sodium to reduce the risk of IDH.

Clinical impact of personalized sodium prescriptions in hemodialysis

2022 ◽  
Vol 35 (4) ◽  
Author(s):  
Mariana Sousa ◽  
◽  
Cristina Santos ◽  
Susana Colaço ◽  
José Santos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Gain ◽  
Serum Sodium ◽  
Statistical Significance ◽  
Extracellular Volume ◽  
Qualitative Assessment ◽  
Sodium Balance ◽  
Patient Specific ◽  
Interdialytic Weight Gain ◽  
Dialysate Sodium

Dialysate sodium prescription is often standardized. In some patients, this can be hypernatremic compared to serum sodium, causing a positive sodium balance at the end of treatment that will contribute to increased extracellular volume and interdialytic weight gain. A prospective study was carried out to monitor and compare the clinical implications between different prescriptions of sodium dialysate (isonatremic versus hyponatremic hemodialysis). For that purpose, we included hemodialysis patients in treatment for at least 9 months. The individual sodium setpoint was determined through the median of pre-dialysis sodium measurements, carried out for 6 treatments. The prescribed dialysate sodium was equal to the setpoint (isonatremic period) for 4 weeks and then 2 meq/L inferior to the setpoint (hyponatremic period) for another 4 weeks. The main outcome was interdialytic weight gain. Secondary outcomes were ultrafiltration rate, blood pressure at the beginning of treatment, intradialytic complications, and qualitative assessment of symptoms. Twenty patients were included. Pre-dialysis serum sodium assessments in both periods tended to be patient specific with a stable value. The interdialytic weight gain was lower in the hyponatremic period (1.83±0.50 kg versus 2.04±0.58 kg) but without statistical significance (p value=0.387). The same trend was found in mean ultrafiltration and blood pressure. Dialysis complications were low in both periods. The percentage of cramps and hypotension requiring intervention was higher in the hyponatremic period with no statistically significant differences. Concerning thirst, there was a symptomatic improvement with sodium customization. This improvement was even more significant in the hyponatremic period. This study allowed us to reinforce the existence of a “sodium setpoint” for each patient and the importance of an individualized dialysis prescription. Our results suggest the safety of using isonatremic hemodialysis with improving patients’ symptoms. Regarding hyponatremic hemodialysis, despite being beneficial, it seemed to be associated with a higher number of complications.

MO730THORACIC BIOIMPEDANCE AS AN INNOVATIVE TOOL TO DETECT CHANGES IN BLOOD PRESSURE DURING HEMODIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Melanie Schoutteten ◽  
Lucas Lindeboom ◽  
Christophe Smeets ◽  
Bart De Moor ◽  
Jacques Peeters ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pearson Correlation ◽  
Extracellular Volume ◽  
The Body ◽  
Whole Body ◽  
P Value ◽  
Predictive Tool ◽  
Low Frequencies ◽  
Dialysis Vintage ◽  
Innovative Tool

Abstract Background and Aims Blood pressure (BP) variability is an important cardiovascular risk factor that contributes to the high burden of cardiovascular mortality in hemodialysis (HD) patients. Ultrafiltration rate (UFR) and plasma refill rate modify the extracellular volume (ECV), which is a major determinant of the systolic BP. Segmental bioimpedance of the thoracic region addresses the central volume compartment of the body. We hypothesize that changes in bioimpedance reflect changes in BP and that thoracic measurements are more accurately in detecting intradialytic BP changes compared to whole body bioimpedance. Method During two consecutive short-term interval HD sessions, thoracic bioimpedance signal was registered continuously from predialysis until the end of the session. Corresponding BP, whole body bioimpedance and ultrafiltration volume (UFV) after the start and at the end of dialysis was registered. After outlier detection, valid raw bioimpedance data [Ohm] at 8 and 160 kHz for thoracic measurements, and 5 and 200 kHz for whole body measurements, were taken into further analysis. Dialysis sessions were divided into 3 groups according to the development of the systolic BP: a drop ≥ than 20 mmHg was defined as a hypotensive session, an increase ≥ 10 mmHg was considered as a hypertensive session. Pearson correlation analysis was applied (r, p-value) to the relative data, calculated as a percentage from the start value. Results From 2 dialysis centres, a total of 46 HD patients were enrolled in the study (65.2% male, mean age 71 ± 12.6 years, mean dialysis vintage 4 ± 3.9 years), which resulted in 89 dialysis sessions to analyse. Mean systolic BP after start of dialysis was 133.2 ± 20.7 mmHg and mean UF volume was 1817.5 ± 801.5 mL. 23 sessions showed a hypotensive gradient from the start till the end of dialysis, and 13 sessions progressed with an increase of more than 10 mmHg. When the 8 kHz curve was plotted according to the 3 BP groups, a more plane increase in thoracic bioimpedance signal was observed in the group with a normal tension course (Figure 1). There was a significant relationship between UFR and changes in relative bioimpedance data, as well as thoracic (r = .49 at 8 kHz, r = .46 at 160 kHz, all ps &lt; .001), as whole body bioimpedance (r = .58 at 5 kHz, r = .52 at 200 kHz, all ps &lt; .001). UFV correlated with changes in systolic BP (r = -.31, p &lt; .01). Both bioimpedance techniques correlated with each other (r = .38, p = .001 for low frequencies; r = .29, p &lt; .01 for high frequencies). Where the relative thoracic bioimpedance signal correlated with changes in systolic BP (r = -.35 at 8kHz, -.32 at 160 kHz, all ps &lt; .01) (Figure 2), whole body did not. Conclusion Thoracic bioimpedance is associated with intradialytic BP changes, whereas whole body bioimpedance is not. Thoracic bioimpedance has the potential to function as an important diagnostic and predictive tool in BP variability during HD.

scholarly journals Diabetes, IMC and high blood pressure during pregnancy

2020 ◽  
Vol 4 (4) ◽  
pp. 043-048
Author(s):  
Bouchra Loukidi ◽  
Baya Guermouche ◽  
Majda Dali-Sahi ◽  
Nouria Dennouni-Medjati ◽  
Hafida Merzouk
Keyword(s):  
Blood Pressure ◽  
At Risk ◽  
Gestational Diabetes ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Perinatal Mortality ◽  
High Blood Pressure ◽  
Logistic Model ◽  
Very High

We investigated factors implicated in the development of pregnant high blood pressure risks and fetal-maternal repercussions. Were evaluated (Age, Gestity, Childbirth type, Eclampsia, Gestational diabetes, Overweight, TA/S, TA/D, Baby’s weight). The logistic model retained, age of mother (OR = 1.17, 95% CI = 1.08-1.27, P < 0.001). The gestity (OR = 2.94, 95% CI = 2.16 - 04.01, P < 0.001. A systolic blood pressure greater than 90 mmHg is at risk (OR= 11.29, 95 % Cl = 1.91 -66.78, P= 0.008).A diastolic blood pressure greater than 140 mmHg (OR = 15.84, 95% CI = 2.67- 66.78, P = 0.002). Gestational diabetes (OR = 2.89, 95% CI = 1.65 - 5.06, < 0.001). The overweight (OR = 25.31, 95% CI = 18.45 - 34.71, P < 0.001). Fetal repercussions are hypotrophy and perinatal mortality. The model established has a very high forecast capacity.

scholarly journals P1246CEREBRAL TISSUE REGIONAL OXYGEN SATURATION AND BLOOD PRESSURE IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Georgios Spanos ◽  
Styliani Paschou ◽  
Christos Dontsios ◽  
Stylianos Fragkidis ◽  
Christos Bantis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Oxygen Saturation ◽  
Vascular Disease ◽  
Near Infrared ◽  
Cerebral Tissue ◽  
Cerebral Disease ◽  
Regional Oxygen Saturation ◽  
Dialysis Vintage

Abstract Background and Aims Patients undergoing hemodialysis (HD) often develop cerebral disease complications. Cerebral tissue regional oxygen saturation (rSO2) through near-infrared spectroscopy (NIRS) is a non-invasive method for cerebral tissue oxygenation monitoring. The aim of the study was to investigate the relationship between rSO2 and hemodialysis in stable HD patients. Additionally, we wanted to investigate how blood pressure during HD is associated with rSO2. Method This is a single centre cross-sectional study in clinically stable HD patients. Cerebral rSO2 was monitored at the forehead 10min before, during and 10min after HD, using an INVOS 5100C device (Medtronic, United Kingdom). Results Thirty-nine stable HD patients (23 men and 16 women; mean age, 62.4 ± 14.6 years were recruited. Dialysis vintage was 65.7 ± 72.1 months, 9 patients had diabetes mellitus, 12 had vascular disease while 14 were smokers. The baseline rSO2 levels (49.6±9.1 %) were significantly lower in HD patients compared with historic results on healthy subjects. We found no difference in rSO2 results in patients with diabetes mellitus, vascular disease or smoking. Although we found a decrease (figure) in rSO2 when patients start dialysis (10min before vs 10min after starting dialysis 49.6±9.1 vs 48.1±9.9 %, p=0.021) rSO2 value returned to baseline after dialysis (10min before vs 10min after dialysis 49.6±9.1 vs 49.9±5.9 %, p=ns. Systolic blood pressure scientifically dropped during the first hour of dialysis (146.7 ± 21.1 vs 137.3 ± 24.6, p=0.03) and systolic blood pressure drop correlated with rSO2. Three patients developed hypotensive episodes requiring iv fluids but these hypotensive episodes had no correlation with rSO2 variations. Conclusion Cerebral rSO2 decreases while patients are on dialysis but return to baseline after dialysis. Blood pressure variations correlate with rSO2 levels but rSO2 do not forecast hypotensive episodes on dialysis.

Paradoxical Hypotension during Dobutamine Infusion for Myocardial Perfusion Scintigraphy

1998 ◽  
Vol 37 (08) ◽  
pp. 268-271
Author(s):  
B. Caner ◽  
E. Atalar ◽  
A. Karanfil ◽  
L. Tokgözoğlu ◽  
E. L. Ergün
Keyword(s):  
Blood Pressure ◽  
Myocardial Perfusion ◽  
Systolic Blood Pressure ◽  
Myocardial Perfusion Scintigraphy ◽  
Stress Test ◽  
Dobutamine Infusion ◽  
Perfusion Scintigraphy ◽  
Tilt Table ◽  
Study Results ◽  
Group A

Summary Aim: Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for TI-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine TI-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μg/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Results: Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39 ± 18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise test, hypotension response to dobutamine is not always a marker for coronary artery disease.

INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE IS ASSOCIATED WITH A HIGH PREVALENCE OF CARDIO VASCULAR DISEASES- A CROSS-SECTIONAL STUDY IN POLICE WORKER

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Somesh Raju ◽  
Rina Kumari ◽  
Sunita Tiwari ◽  
NS Verma
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Sugar ◽  
Pressure Difference ◽  
Systolic Pressure ◽  
Working Environment ◽  
Vascular Events ◽  
Cross Sectional ◽  
Blood Pressure Difference ◽  
High Prevalence

Background: Interarm systolic blood pressure difference more than 10 mm of Hg is predictor of cardiovascular and metabolic risk. Despite of sufficient physical activity there is high prevalence of obesity in police personal because of stressful working environment. No studies have addressed the significance of interarm pressure difference among them. Therefore, the present study conducted to access the relation of interarm blood pressure difference with obesity in police personnel. Aims and Objective: To estimate the interarm pressure difference in police personal to see its association with their obesity. Material and Method: This cross-sectional observational study done on 245 police workers in PAC, Sitapur, India. Subjects having more than ten years of working experience were included in study. Anthropometric measurements of subject recorded by following standard protocol. Measurement of systolic pressure in both arm recorded simultaneously by mercury sphygmomanometer. Available data analyze and expressed in percentage, mean with SD and chi square test to see the significance of association. Results: According to anthropometric results of subjects 77.14 prcent subjects were having generalised obesity and 82.04 percent of subjects having abdominal obesity. 34.29 percent of subjects showed abnormally high (?10 mmHg) inter-arm systolic blood pressure difference. Both type of obesity showed positive association with blood sugar level but no association with interarm pressure difference. Conclusion: Interarm blood pressure difference is greater in individual having obesity or prolong duration of service. Such subjects are more susceptible to develop coronary artery disease or peripheral arterial disease in future. Early screening can help to detect the vascular events likely to occur in the future Keywords: Body mass index, Waist circumference, Interarm pressure difference, Random blood sugar

EFEKTIVITAS PEMBERIAN HYDROTHERAPI RENDAM KAKI PADA PENDERITA HIPERTENSI DI BANJAR SRI MANDALA, KELURAHAN DAUHWARU KABUPATEN JEMBRANA

2019 ◽  
Vol 10 (01) ◽  
pp. 33-44
Author(s):  
N.L.G. Sudaryati ◽  
I P. Sudiartawan ◽  
Dwi Mertha Adnyana
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Reduce Blood Pressure ◽  
Second Grade ◽  
Control Group ◽  
Hypertensive Patients ◽  
First Category

The aim of the study was to determine the effectiveness of giving hydrotherapi foot soak in hypertensive patients. The study was conducted with one group pretestposttest design without a control group by measuring blood pressure (pretest) before being given an intervention in the form of foot soak hydrotherm against 15 people with hypertension in Banjar Sri Mandala, Dauhwaru Village, Jembrana Subregency. Then do the blood pressure measurement again (posttest) after finishing the intervention. After the study was completed, the results showed that before the hydrotherapi foot bath intervention, there were 0% of patients classified as normal, 13.32% in prehypertension category, 60.08% in hypertension category I and 26.60% in hypertension category II. After the intervention was given, there were 13.32% of the patients classified as normal, 66.68% in the prehypertension category, 20.00% in the first category of hypertension and no patients belonging to the second grade hypertension category. There is a decrease of 20-30 mmHg for systolic blood pressure and 0-10 mmHg for diastolic blood pressure after intervention. Based on the results of the study it can be concluded that the hydrotherapi foot bath is effectively used to reduce blood pressure in hypertensive patients in the Banjar Sri Mandala, Dauhwaru Village, Jembrana District.

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