title: Feasibility of intermittent back-filtrate infusion hemodiafiltration to reduce intradialytic hypotension in patients with cardiovascular instability: a pilot study.
abstract: BACKGROUND
  Intradialytic hypotension (IDH) is one of the major problems in performing safe hemodialysis (HD). As blood volume depletion by fluid removal is a major cause of hypotension, careful regulation of blood volume change is fundamental. This study examined the effect of intermittent back-filtrate infusion hemodiafiltration (I-HDF), which modifies infusion and ultrafiltration pattern.
  
  
  METHODS
  Purified on-line quality dialysate was intermittently infused by back filtration through the dialysis membrane with a programmed dialysis machine. A bolus of 200 ml of dialysate was infused at 30 min intervals. The volume infused was offset by increasing the fluid removal over the next 30 min by an equivalent amount. Seventy-seven hypotension-prone patients with over 20-mmHg reduction of systolic blood pressure during dialysis or intervention-requirement of more than once a week were included in the crossover study of 4 weeks duration for each modality. In a total of 1632 sessions, the frequency of interventions, the blood pressure, and the pulse rate were documented.
  
  
  RESULTS
  During I-HDF, interventions for symptomatic hypotension were reduced significantly from 4.5 to 3.0 (per person-month, median) and intradialytic systolic blood pressure was 4 mmHg higher on average. The heart rate was lower during I-HDF than HD in the later session. Older patients and those with greater interdialytic weight gain responded to I-HDF.
  
  
  CONCLUSIONS
  I-HDF could reduce interventions for IDH. It is accompanied with the increased intradialytic blood pressure and the less tachycardia, suggesting less sympathetic stimulation occurs. Thus, I-HDF could be beneficial for some hypotension-prone patients.
  000013816.
authors.affiliation: Koda Medical and Dialysis Clinic, 3748 Yoshida, Tsubame, Niigata, 959-0264, Japan. ykodan@gmail.com.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Koda
authors.affiliation: Koyo Medical Clinic, Konan-ku, Niigata, 950-0121, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Aoike
authors.affiliation: Kashiwazaki General Medical Center, Kashiwazaki, Niigata, 945-8535, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Hasegawa
authors.affiliation: Niigata Rinko Hospital, Higashi-ku, Niigata, 950-8725, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osawa
authors.affiliation: Nakagawa Medical Clinic, Utsunomiya, Tochigi, 321-0157, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Iwabuchi Clinic, Utsunomiya, Tochigi, 320-0811, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Iwabuchi
authors.affiliation: Gyoda General Hospital, Gyoda, Saitama, 361-0056, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Iwahashi
authors.affiliation: Kuki General Hospital, Kuki, Saitama, 346-0021, Japan.
authors.forename: Tokuichiro
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Ogawa Hospital, Hiki, Saitama, 355-0317, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kikutani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001810:Blood Volume; D002319:Cardiovascular System / Q000294:innervation / Q000503:physiopathology*; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006339:Heart Rate; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007564:Japan; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D015314:Dialysis Solutions
keywords: Hemodiafiltration; Hypotension; Intermittent back-filtrate infusion