title: Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability. Results from a randomized controlled study.
abstract: BACKGROUND
  Intradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH.
  
  
  METHODS
  Fifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment. HFR-Aequilibrium (HFR-Aeq) is an evolution of the haemofiltration with endogenous reinfusion (HFR) dialysis therapy, with dialysate sodium concentration and ultrafiltration rate profiles elaborated by an automated procedure. The primary end point was the frequency of IDH.
  
  
  RESULTS
  Symptomatic hypotension episodes were significantly lower on HFR-Aeq versus HFR (23 ± 3 versus 31 ± 4% of sessions, respectively, P l= l0.03), as was the per cent of clinical interventions (17 ± 3% of sessions with almost one intervention on HFR-Aeq versus 22 ± 2% on HFR, P <0.01). In a post-hoc analysis, the effect of HFR-Aeq was greater on more unstable patients (35 ± 3% of sessions with hypotension on HFR-Aeq versus 71 ± 3% on HFR, P <0.001). No clinical or biochemical signs of Na/water overload were registered during the treatment with HFR-Aeq.
  
  
  CONCLUSIONS
  HFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na(+) measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice.
authors.affiliation: Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy. f.locatelli@ospedale.lecco.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Sergio
authors.initials: S
authors.lastname: Stefoni
authors.forename: Thierry
authors.initials: T
authors.lastname: Petitclerc
authors.forename: Luigi
authors.initials: L
authors.lastname: Colì
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Filippo
authors.forename: Simeone
authors.initials: S
authors.lastname: Andrulli
authors.forename: Christine
authors.initials: C
authors.lastname: Fumeron
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Frascà
authors.forename: Sibilla
authors.initials: S
authors.lastname: Sagripanti
authors.forename: Silvana
authors.initials: S
authors.lastname: Savoldi
authors.forename: Andrea
authors.initials: A
authors.lastname: Serra
authors.forename: Carmine
authors.initials: C
authors.lastname: Stallone
authors.forename: Filippo
authors.initials: F
authors.lastname: Aucella
authors.forename: Antonio
authors.initials: A
authors.lastname: Gesuete
authors.forename: Antonio
authors.initials: A
authors.lastname: Scarlatella
authors.forename: Francesco
authors.initials: F
authors.lastname: Quarello
authors.forename: Paola
authors.initials: P
authors.lastname: Mesiano
authors.forename: Peter
authors.initials: P
authors.lastname: Ahrenholz
authors.forename: Roland
authors.initials: R
authors.lastname: Winkler
authors.forename: Lise
authors.initials: L
authors.lastname: Mandart
authors.forename: Joan
authors.initials: J
authors.lastname: Fort
authors.forename: Christian
authors.initials: C
authors.lastname: Tielemans
authors.forename: Carlo
authors.initials: C
authors.lastname: Navino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001676:Biofeedback, Psychology / Q000379:methods*; D001794:Blood Pressure; D018592:Cross-Over Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010953:Plasma Volume / Q000502:physiology; D011446:Prospective Studies; D012964:Sodium / Q000097:blood*; D013997:Time Factors
chemical_list: D012964:Sodium