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Evaluation of intradialytic hypotension using impedance cardiography.
MedLine Citation:
PMID:  20449654     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Hypotension during hemodialysis is frequent in patients with cardiovascular disease who have a limited physiological compensatory response. Recent advances in technology allow non-invasive monitoring of cardiac output and derived hemodynamic parameters. This prospective study evaluated episodes of intradialytic hypotension using clinical data and continuous non-invasive hemodynamic monitoring by impedance cardiography.
METHODS: Forty-eight chronic hemodialysis patients, with prevalence for intradialytic hypotensive episodes, underwent evaluation with non-invasive impedance cardiography (Physioflow(®)) before, during and after a regular dialysis session.
RESULTS: During continuous non-invasive cardiac monitoring, a fall of systolic arterial blood pressure of 20% or more at least once during hemodialysis was detected in 18 patients (37.5%)-thereafter identified as the "Unstable" group. In 30 patients-thereafter called the "Stable" group, the blood pressure did not change significantly. During hypotension, a decrease in cardiac output was found in 11 of the 18 unstable patients, and a significant fall in peripheral resistance in the remaining 7. End-diastolic filling ratio was significantly lower in the unstable group. The most significant predictors associated with intradialytic hypotension were the presence of ischemic heart disease (P = 0.05), and medication with beta blockers (P = 0.037) and calcium channel blockers (P = 0.018).
CONCLUSIONS: Hemodynamic changes in dialysis patients with hypotensive episodes included decreased cardiac output or decreased peripheral resistance. A lower end-diastolic filling ratio may be regarded as a marker for reduced preload in these patients. Non-invasive impedance cardiography may be used to evaluate risk factors for hypotension in dialysis patients.
Abed Bayya; Dvora Rubinger; David Michael Linton; Sigal Sviri
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Publication Detail:
Type:  Journal Article     Date:  2010-05-07
Journal Detail:
Title:  International urology and nephrology     Volume:  43     ISSN:  1573-2584     ISO Abbreviation:  Int Urol Nephrol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0262521     Medline TA:  Int Urol Nephrol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  855-64     Citation Subset:  IM    
Medical Intensive Care Unit, Division of Medicine, Hadassah-University Medical Centre, Ein Kerem, Jerusalem, 91120, Israel.
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