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

Kamonwan Tangvoraphonkchai1, Andrew Davenport2

  • 1Department of Renal Medicine, Mahasarakham University Hospital, Mahasarakham, Thailand.

The International Journal of Artificial Organs
|February 22, 2021
PubMed

Insights

Intra-dialytic hypotension (IDH) is common during hemodialysis (HD). This study found that a greater reduction in extracellular volume (ECW) during HD is associated with a drop in systolic blood pressure (SBP), suggesting ECW monitoring could prevent IDH.

Area of Science:

  • Nephrology
  • Cardiovascular Physiology
  • Bioengineering

Background:

  • Intra-dialytic hypotension (IDH) is a frequent complication during outpatient hemodialysis (HD) sessions.
  • Fluid removal during HD leads to extracellular volume (ECW) contraction.
  • The relationship between ECW changes and systolic blood pressure (SBP) during HD requires further investigation.

Purpose of the Study:

  • To determine if the reduction in ECW during HD is associated with a fall in SBP.
  • To identify factors influencing ECW changes and their correlation with hemodynamic stability during dialysis.

Main Methods:

  • Retrospective review of adult dialysis outpatients undergoing midweek HD sessions.
  • Pre- and post-HD bioimpedance measurements of ECW were analyzed.
  • Correlation and logistic regression models were used to assess associations between ECW, SBP, and other clinical variables.

Main Results:

  • A significant association was observed between the percentage fall in ECW (ECW%) and post-dialysis SBP (r = -0.14, p < 0.001).
  • Patients experiencing SBP falls >20 mmHg showed a greater ECW% reduction compared to those with stable SBP.
  • Increased ECW% fall was linked to weight loss, longer session duration, and negatively correlated with hemodiafiltration and dialysate sodium-to-plasma gradient.

Conclusions:

  • A clear association exists between ECW reduction and SBP changes during dialysis.
  • Monitoring ECW fluctuations during HD is recommended.
  • Developing biofeedback devices to manage ultrafiltration and dialysate sodium could mitigate IDH risk.
Abstract

Keywords:
Dialysate sodiumextracellular waterhemodialysisintradialytic hypotension

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