title: Are serum to dialysate sodium gradient and segmental bioimpedance volumes associated with the fall in blood pressure with hemodialysis?
abstract: BACKGROUND
  A fall in blood pressure is the most common complication of outpatient hemodialysis. Several factors have been implicated, including serum sodium to dialysate gradient, ultrafiltration rate, and the amount of fluid to be removed during dialysis.
  
  
  METHODS
  We prospectively audited 400 adult patients attending for their routine midweek hemodialysis session, and recorded changes in mean arterial blood pressure (MAP).
  
  
  RESULTS
  Mean age 58.4 ± 16.6 years, 60.9% male, 30.7% diabetic, 36.8% Caucasoid, single pool Kt/V 1.57 ± 0.4, and median percentage change in MAP -6.7% (-14.1 to + 2.8). The percentage fall in MAP was greatest for those starting with higher MAPs (β 0.448 , F 67.5, p<0.001), greater serum sodium to dialysate sodium gradient (β 0.676, F 5.59, p = 0.019), and age (β 0.163, F 5.15, p = 0.024). In addition, the percentage fall in MAP was greater in those with the lowest segmental extracellular water/total body water (ECW/TBW) ratios in the right arm prior to dialysis (β -477.5, F 7.11, p = 0.008).
  
  
  CONCLUSIONS
  Falls in blood pressure are common during dialysis, and greater for those starting dialysis with the highest systolic pressures, greater dialysate to serum sodium concentration gradient, and also those with the least ECW in the arm. As such, segmental bioimpedance may be useful in highlighting patients at greatest risk for a fall in blood pressure with dialysis.
authors.affiliation: UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London - UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Maryam
authors.initials: M
authors.lastname: Khosravi
authors.forename: Annick
authors.initials: A
authors.lastname: Massart
authors.forename: Madhu
authors.initials: M
authors.lastname: Potluri
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D015314:Dialysis Solutions / Q000494:pharmacology*; D017097:Electric Impedance; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000503:physiopathology; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D012964:Sodium / Q000097:blood*; D014883:Water-Electrolyte Imbalance / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D015314:Dialysis Solutions; D006454:Hemoglobins; D010446:Peptide Fragments; D012709:Serum Albumin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D012964:Sodium