Dialysis fata morgana: can we finally successfully tackle intradialytic hypotension with plasma sodium biofeedback systems?
| Autor: | Luminita Voroneanu, Adrian Covic |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
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| Zdroj: | Nephrology Dialysis Transplantation |
| ISSN: | 1460-2385 |
| Popis: | In spite of all the progress made in dialysis treatment, in-tradialytic hypotension (IDH) is still one of the mostcommon complications of standard thrice-weekly haemo-dialysis (HD). It occurs in ∼20–30% of all dialysis ses-sions [1]. IDH is the clinical manifestation of a netreduction in the effective circulating plasma volume in ashort period of time, overwhelming normal compensatorymechanisms, including plasma refilling and reduction invenous capacity, due to the reduction in pressure trans-mission to veins [2]. The aetiology of IDH is multifactor-ial: autonomic dysfunction in uraemia, acute decrease inplasma osmolarity, reduction in vascular reactivity to va-sopressor agents and overproduction of vasodilators, anincorrectly estimated ‘dry weight’ resulting in a too highfiltration rate and overdosage of antihypertensive drugs—most often (but not necessarily) in addition to diabetes orcoexistence of cardiovascular diseases [3].Over many years, there has been a major effort to de-crease the frequency of IDH. Besides patient discomfort(one of the two most frequent complains in patient dialy-sis-related QOL questionnaires [4]), this quest has beenobjectively motivated by the serious cardiovascular com-plications associated with IDH. Indeed, recurrent episodesof IDH are associated with repetitive transient myocardialhypoperfusion; moreover, repetitive ischaemia and reperfu-sion induce myocardial fibrosis and ventricular dysfunc-tion, life-threatening arrhythmias and sudden cardiac death[5, 6]. After symptomatic IDH episodes, HD patients sufferoccult but significant myocardial injuries reflected byhigher serum levels of CK-MB and cTnT, observed even44 h after the end of the dialysis session [7]. RepetitiveIDH is also associated with cerebral ischaemia, and thedevelopment of lacunar and watershed infarcts withsubsequent atrophy of the frontal lobe of the brain [8].Moreover, IDH is an independent negative predictor oflong-term fistula outcomes [ 9, 10].Intra-dialytic hypotension is independently associatedwith higher mortality in HD patients, including reportsprovided by prospective cohort studies [11]. In 1244 HDpatients, a significant association was found between thelowest intradialysis systolic blood pressure (SBP) and2-year mortality (patients with intradialytic blood pressure(BP) values |
| Databáze: | OpenAIRE |
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