Prolonged protective effect of short daily hemodialysis against dialysis-induced hypotension.
OBJECTIVE
Short daily hemodialysis (HD) has a protective effect against dialysis-induced hypotension (DIH). We examined whether this effect extends beyond the treatment period.


METHODS
We analyzed clinical variables in 6 patients (5 with diabetes mellitus) who underwent conventional hemodialysis (CHD) for 4 h three times weekly for 12 weeks; then short daily HD for 2 h six times weekly for 12 weeks, and then 12 more weeks of CHD. All patients had been given vasopressors for severe DIH.


RESULTS
The severe DIH disappeared during the short daily HD. There were significant decreases in body weight (BW), cardiothoracic ratio (CTR), blood pressure (BP), normal saline solution (NSS) amount (62.8 +/- 26.4 vs. 9.8 +/- 7.4 ml/session, p < 0.05), frequency (0.60 +/- 0.26 vs. 0.10 +/- 0.07 infusions/session, p < 0.05) and postdialysis atrial natriuretic peptide (ANP) (176.8 +/- 56.4 vs. 104.8 +/- 42.3 pg/ml, p < 0.05). Weekly ultrafiltration volume (6.3 +/- 0.9 vs. 7.9 +/- 0.7 l, p < 0.05) was significantly higher during the short daily HD period than during the first CHD period. The vasopressor treatment was therefore stopped or reduced in all patients during the short daily HD period. Because DIH recurred in the second CHD period despite a significant increase in BP, the vasopressor treatment was resumed in 5 patients. BW, CTR, NSS infusion amount and frequency, or postdialysis ANP did not differ significantly between the short daily HD and second CHD periods.


CONCLUSIONS
The protective effect of short daily HD against DIH lasted more than 12 weeks after the treatment ended. We therefore conclude that temporary short daily HD is useful for preventing DIH.
Okada
Kazuyoshi
K
Division of Nephrology and Endocrinology, Department of Medicine, Nihon University School of Medicine,Tokyo, Japan. kokada@med.nihoniu.ac.jp
Abe
Masanori
M
Hagi
Chihiro
C
Maruyama
Takashi
T
Maruyama
Noriaki
N
Ito
Ken
K
Higuchi
Terumi
T
Matsumoto
Koichi
K
Takahashi
Susumu
S
D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001071:Appointments and Schedules; D001166:Arteriovenous Shunt, Surgical; D009320:Atrial Natriuretic Factor / Q000097:blood; D001794:Blood Pressure; D001835:Body Weight; D003928:Diabetic Nephropathies / Q000628:therapy; D004452:Echocardiography; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000209:etiology; D007022:Hypotension / Q000209:etiology* / Q000517:prevention & control*; D007501:Iron / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011788:Quality of Life; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods*; D014511:Uremia / Q000150:complications / Q000628:therapy
D000959:Antihypertensive Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D005293:Ferritins; D007501:Iron