Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial.
BACKGROUND
Recently we have devised and tested a biofeedback system for controlling blood volume (BV) changes during hemodialysis (HD) along an ideal trajectory (blood volume tracking, BVT), continuously modifying the weight loss rate and dialysate conductivity. This multicenter, prospective, randomized, crossover study aimed to clarify whether BVT (treatment B) can improve hypotension-prone patients' treatment tolerance, compared with conventional hemodialysis (treatment A).


METHODS
Thirty-six hypotension-prone patients enrolled from 10 hemodialysis (HD) centers were randomly assigned to either of the study sequences ABAB or BABA, each lasting four months.


RESULTS
A 30% reduction in intradialytic hypotension (IDH) events was observed in treatment B as compared with A (23.5% vs. 33.5%, P = 0.004). The reduction was related to the number of IDH in treatment A (y = 0.54x + 5; r = 0.4; P < 0.001): the more IDH episodes in treatment A, the better the response in treatment B. The best responders to treatment B showed pre-dialysis systolic blood pressure values higher than the poor responders (P = 0.04). A 10% overall reduction in inter-dialysis symptoms was obtained also in treatment B compared to A (P < 0.001). Body weight gain, pre-dialysis blood pressure, intradialytic weight loss as well as Kt/V did not differ between the two treatments.


CONCLUSIONS
An overall improvement in the treatment tolerance was observed with BVT, particularly intradialytic cardiovascular stability. Patients with the highest incidence of IDH during conventional HD and free from chronic pre-dialysis hypotension seem to respond better. Inter-dialysis symptoms also seem to improve with control of BV.
Santoro
Antonio
A
Divisione de Nefrologia e Dialisi Malpighi, Policlinico S. Orsola-Malpighi, Via P. Palagi 9, 40138 Bologna, Italy. santoro@orsola-malpighi.med.unibo.it
Mancini
Elena
E
Basile
Carlo
C
Amoroso
Luigi
L
Di Giulio
Salvatore
S
Usberti
Mario
M
Colasanti
Giuliano
G
Verzetti
Giuseppe
G
Rocco
Alessandro
A
Imbasciati
Enrico
E
Panzetta
Giovanni
G
Bolzani
Roberto
R
Grandi
Fabio
F
Polacchini
Maurizio
M
D000368:Aged; D001794:Blood Pressure; D001810:Blood Volume; D005260:Female; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome