Risk Factors And Prevention Of Intradialytic Hypotension In Hemodialysis Patients With Maintenance Hemodialysis

Hemodialysis(HD),one of the renal replacement therapies for patients with end-stage renal disease(ESRD),is widely used in clinical practice.Although hemodialysis techniques are improving day by day,the incidence of hypotension(IDH)in dialysis remains high level.IDH is one of the main risk factors for high mortality in patients.Due to its undefined definition,the incidence rate varies.At present,the definition of IDH in the European best practice guideline standards has begun to be widely accepted,but less research has been conducted on the incidence of IDH under this definition.The occurrence of IDH is affected by many factors,such as long HD time,large body mass index(BMI),large ultrafiltration volume,difficulty in achieving target body mass,low basal blood pressure,and high dialysate temperature,but there are inconsistencies in different reported results.In recent years,IDH prevention research has begun to increase.At present,common methods include low temperature adjustable sodium curve ultrafiltration dialysis method and sequential dialysis method.The use of online blood volume monitoring(BVM)to reduce IDH during dialysis has received much attention recently,but there are less relevant reports.In order to further explore the risk factors and preventive measures of IDH,this study intends to retrospectively analyze patients in our blood purification center and observe the incidence of IDH under the European best practice guidelines and investigate the risk factors of IDH and the prevention effect of BVM monitoring on IDH,so as to provide evidence for clinical prevention and treatment of IDH and improve the prognosis of patients.1.Analysis of hypotension during dialysis in maintenance hemodialysis patients Objective To investigate the occurrence of IDH in maintenance hemodialysis(MHD)patients under the definition of IDH in the European Best Practice Guidelines.Methods The data of MHD patients from the Department of Blood Purification Center of Zhongda Hospital Affiliated to Southeast University from June 2017 to December 2017 were collected to analyze the occurrence and trends of IDH.Results 332 patients met the inclusion criteria.Of a total of 21,772 dialysis treatments,systolic blood pressure(SBP)decreased ≥20 mmHg to 7439(34.1%),and mean arterial pressure(MAP)decreased ≥10 mmHg to 8,422(38.7%).There were 4115cases(18.9%)of IDHs involved in the above two cases with clinical symptoms requiring intervention.The average values of systolic blood pressure,mean arterial pressure,and heart rate changes before and after dialysis were-5±18 mmhg,-2±12mmHg,and 1.9±11.7 beats/min.With the increase of dialysis time,the incidence of IDH showed an upward trend and was highest at 3.5 hours after dialysis.Conclusion Under the definition of the European best practice guidelines,the incidence rate of IDH in this center was 18.9%.After dialysis,systolic blood pressure,diastolic blood pressure,mean arterial pressure decreased,heart rate became faster,and the incidence of IDH was the highest 3.5 hours after dialysis.2.Study on risk factors of hypotension during dialysis in maintenance hemodialysis patients Objective Elucidate risk factors for IDH in dialysis patients with MHD.Methods To collect MDH patient data from June 2017 to December 2017 in the Department of Nephrology,Zhongda Hospital Affiliated to Southeast University,including blood pressure,diabetes,ultrafiltration volume/body weight,left ventricular ejection fraction(EF),and hematocrit(Hct),hemoglobin(Hb),serum albumin(Alb),serum total protein(TP)and so on.According to whether patients with IDH were divided into two groups during the dialysis process,namely hypotension group(IDH)and no hypotension group(no-IDH),logistic regression was used to analyze IDH-related risk factors in hemodialysis.Results 87 patients met the inclusion criteria,including 48 patients in the IDH group and 39 patients in the no-IDH group.The results of logistics regression analysis showed that the higher the ultrafiltration volume/body weight,the greater the risk of IDH(P<0.05).The OR value was 2.35(95% CI=1.17-4.69).No risk of IDH wasVI found associated with diabetes,EF,Hct,Hb,Alb,and TP.The AUC of IDH in patients with MHD predicted by ultrafiltration volume/body weight was 0.62.Conclusion Ultrafiltration volume/body weight is a risk factor for IDH in patients with MHD.3.Prevention of Hypotension Complicating Dialysis in Maintenance Hemodialysis Patients Objective To investigate the application of blood volume monitoring(BVM)in hemodialysis and its preventive effect on hypotension during dialysis in MHD patients.Methods To collect data on MHD patients who used BVM for at least 3 months between June 2017 and December 2017 at the Blood Purification Center of the University of Southeast University Affiliated Zhongda Hospital.Using its own pre-and post-contrast controls,the changes in blood pressure,blood volume,and IDH incidence were analyzed.The correlation between systolic blood pressure and blood volume was discussed carefully,and the preventive effect of BVM on IDH was analyzed.Results During the 936 dialysis sessions,the systolic blood pressure and blood volume of IDH patients showed a downward trend.Correlation analysis showed that there was a good correlation between systolic blood pressure and blood volume changes at 2 h,3 h,and 4 h(P<0.05).Regression analysis showed that the systolic blood pressure decreased by 1.6mmHg,2.29 mmHg and 2.21 mmHg respectively for every 1% reduction in the blood volume of 2h,3h and 4h in dialysis.The prevalence of IDH was 25.0% before BVM use and 10.9% after BVM was used.The incidence of IDH in MHD patients after BVM use was significantly reduced.Conclusion There is a close correlation between systolic blood pressure and changes in blood volume during dialysis.Using BVM can significantly reduce the incidence of IDH in patients with MHD.In summary,this study observed the incidence of IDH in the blood purification center of our hospital,and discussed the risk factors of IDH and the preventive effect of BVM monitoring on IDH.The results showed that according to the definition ofIDH in the European Best Practice Guidelines,the incidence rate of IDH in this center was 18.9%;Hyper-filtration/weight was a risk factor for the occurrence of IDH;systolic blood pressure and blood volume change during dialysis.Closely related,BVM has a preventive effect on reducing the incidence of IDH in dialysis.This study provides a theoretical basis for prevention and treatment of IDH in patients with clinical dialysis.