Abstract: SA-PO770

Lower Blood Flow Rate in the Last Quarter of Hemodialysis May Protect Against Hypotension

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Backenroth, Rebecca, Hadassah U Med Center, Jerusalem, Israel
  • Rubinger, Dvora, Hadassah U Med Center, Jerusalem, Israel
  • Kab, Tasneem, Hadassah u med center, Jerusalem, Israel
  • Mor yosef levi, Irit, Hadassah, Jerusalem, Israel
  • Sapoznikov, Dan, Hadassah U Med Center, Jerusalem, Israel
Background

In hemodialysis (HD), high blood flow rate (BFR) increases clearances and decreases clotting of the extracorporeal circuit. However, possible adverse effects are not well delineated.

Methods

A prospective crossover study compared the effects of higher vs lower BFR, with patients serving as their own controls. Consenting stable adults on chronic HD were studied for 2 sessions in random order usually a week apart. The control session, with 'high' constant BFR, 300-450 cc/min, and the variable flow session, alternating high then low, 250 cc/min BFR in 4 equal periods of the session. Continuous beat to beat BP and pulse were monitored noninvasively by Finometer TM, O2 saturation by pulse oximeter, and subjective wellbeing by questionnaires.

Results

Twelve patients in 24 HD sessions were studied. Baseline weight, pulse, interdialytic weight gain and UF rates were similar in the sessions but intial systolic BP (SBP) was higher in the control HD.
In the control HD, SBP declined while the diastolic BP (DBP) declined only in the 4th quarter.

The variable flow HD was similar until the last quarter, when lower BFR was associated with significant reversal of the decline of SBP and DBP, and a rise in DBP.
Pulse increased insignificantly during both sessions.
Autonomic parameters were similar except LFα (index of baroreflex sensitivity) which increased in the control, but decreased in the 4th, lower BFR period (p=0.03).
Total peripheral resistance also differed only in the 4th period, when it decreased in the control, but increased in the variable BFR group.
Stroke volume was significantly higher in the 1st period of low BFR, and cardiac output decreased in both sessions.
SBP did not correlate with cardiac output.
Subjective feelings and O2 sat were similar in both sessions.

Conclusion

Low BFR during the last quarter of HD seems to attenuate decreases in both SBP and DBP.

Funding

  • Clinical Revenue Support