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Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial.
- Source :
-
American journal of nephrology [Am J Nephrol] 2017; Vol. 45 (5), pp. 409-416. Date of Electronic Publication: 2017 Apr 14. - Publication Year :
- 2017
-
Abstract
- Background: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer.<br />Methods: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) ≥20 mm Hg.<br />Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone.<br />Conclusion: Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal.<br /> (© 2017 S. Karger AG, Basel.)
- Subjects :
- Adult
Blood Pressure Determination
Body Water
Cross-Over Studies
Dialysis Solutions analysis
Female
Hemodynamics
Humans
Hypotension blood
Hypotension etiology
Kidney Failure, Chronic blood
Male
Middle Aged
Treatment Outcome
Ultrafiltration
Exercise Therapy methods
Hypotension prevention & control
Intermittent Pneumatic Compression Devices
Kidney Failure, Chronic therapy
Phosphates analysis
Renal Dialysis adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1421-9670
- Volume :
- 45
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American journal of nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 28407637
- Full Text :
- https://doi.org/10.1159/000471513