title: A pilot study of routine colloid infusion in hypotension-prone dialysis patients unresponsive to preventive measures.
abstract: OBJECTIVE
  Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis. The aim of this study was to assess the effects of routine infusion of 20% albumin and 4% gelatin in dialysis hypotension-prone patients unresponsive to prevention measures.
  
  
  METHODS
  This was a prospective crossover study (lasting 20 weeks) of routine infusion of 200 mL of these colloids in 10 patients. We analyzed the effect of these colloids by n-of-1 trial methodology (Wilcoxon test) and analysis of variance.
  
  
  RESULTS
  Twenty percent albumin increased systolic blood pressure (SBP) in 6 patients (p<0.05), whereas 4% gelatin improved SBP in only 2 patients (p<0.05). Albumin infusions increased diastolic blood pressure (DBP) in 4 patients (p<0.05), whereas gelatin improved DBP in only 1 patient (p<0.05). Weight gain between dialysis sessions was generally similar during the periods in most patients. An increase in the ultrafiltration rate was observed in 4 of the 6 patients whose blood pressure was improved by colloids (p<0.005). Kt/V and the fall in relative blood volume remained stable during the study, whereas ionic dialysance at the end of the dialysis sessions was improved only by albumin infusion (p<0.05, repeated measures ANOVA).
  
  
  CONCLUSIONS
  Systematic colloids infusion during hemodialysis sessions improves hemodynamic parameters in most dialysis hypotension-prone patients unresponsive to usual measures of prevention. Prospective controlled trials are warranted to confirm these preliminary results.
authors.affiliation: Division of Nephrology and Dialysis, Centre Hospitalier Privé Claude Galien, Quincy Sous Senart, France. rostotom@orange.fr
authors.forename: Guy
authors.initials: G
authors.lastname: Rostoker
authors.forename: Mireille
authors.initials: M
authors.lastname: Griuncelli
authors.forename: Christelle
authors.initials: C
authors.lastname: Loridon
authors.forename: Thomas
authors.initials: T
authors.lastname: Bourlet
authors.forename: Eric
authors.initials: E
authors.lastname: Illouz
authors.forename: Abbes
authors.initials: A
authors.lastname: Benmaadi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002908:Chronic Disease; D003102:Colloids; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005780:Gelatin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D016037:Single-Blind Method; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
chemical_list: D000418:Albumins; D003102:Colloids; D005780:Gelatin