Hemodialysis prescription education decreases intradialytic hypotension.
BACKGROUND
Intradialytic hypotension (IDH) is associated with increased morbidity and mortality. We studied the impact of an education program and hemodialysis (HD) prescription optimization on the frequency of IDH.


METHODS
We compared chronic HD patients during 2 retrospective time periods: a control period and the study period which occurred after 2 months of physician education and HD prescription optimization. Primary study outcomes were the frequency of HD sessions complicated by IDH, and the prevalence of IDH-prone patients.


RESULTS
There were 91 and 82 patients in the control and study periods, respectively. In the study period, 11% (115/1107) of HD sessions were complicated by IDH vs. 17% (189/1103) in the control period (p = 0.0002). There was a decreased odds ratio for IDH in the study period compared with control (odds ratio [OR] = 0.59; 95% confidence interval [95% CI], 0.40-0.86; p = 0.007). Compared with control, more patients in the study period were prescribed at least 2 preventative strategies (42% vs. 61%, p = 0.02), including increased use of cool dialysate (55% vs. 89%, p<0.001). Cool dialysate reduced the odds of IDH by 50% (OR = 0.50; 95% CI, 0.30-0.86; p = 0.012).


CONCLUSIONS
HD prescription education with concurrent use of multiple preventative strategies is associated with a significant decrease in IDH.
Department of Medicine, University of Calgary, Calgary, Alberta - Canada; and Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Davina J
DJ
Tai
Joslyn
J
Conley
Pietro
P
Ravani
Brenda R
BR
Hemmelgarn
Jennifer M
JM
MacRae
D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D004502:Education, Medical, Continuing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000193:education*; D016017:Odds Ratio; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome