Abstract: SA-OR068
A Randomized Controlled Trial of Albumin Versus Saline for the Prevention of Intradialytic Hypotension in Hypoalbuminemic Patients
Session Information
- Improving Dialysis Delivery and Patient Outcomes
October 27, 2018 | Location: 2, San Diego Convention Center
Abstract Time: 04:30 PM - 04:42 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Macedo, Etienne, University of California San Diego Medical Center, La Jolla, California, United States
- Karl, Bethany E., University of California San Diego Medical Center, La Jolla, California, United States
- Jacinto, Lea Descallar, University of California San Diego Medical Center, La Jolla, California, United States
- Lee, Euyhyun, University of California San Diego Medical Center, La Jolla, California, United States
- Mehta, Ravindra L., University of California San Diego Medical Center, La Jolla, California, United States
Background
Intradialytic hypotension (IDH) is a frequent complication in hypoalbuminemic patients with AKI or ESRD limiting adequate fluid removal and increasing the risk for vascular access thrombosis, early hemodialysis (HD) termination, and mortality. Albumin infusion before and during therapy has been used for preventing and treating hypotension with varying results. We evaluated the efficacy of albumin infusion in preventing intradialytic hypotension during HD.
Methods
A randomized, crossover trial was performed in 65 patients with albumin<3g/dl with AKI or ESRD who required HD during hospitalization. Patients were randomized to receive 100mL of either 0.9% sodium chloride or 25% albumin intravenously prior to their first dialysis session and alternated between the two solutions for up to 6 sessions. Patients’ vital signs and ultrafiltration removal rate were recorded every 15 to 30 minutes during HD. All symptoms associated with hypotension as well as interventions during the dialysis were recorded. IDH was assessed by different definitions reported in the literature (Table).
Results
65 patients completed 249 sessions; mean age was 58(+/-12), 46(70%) were male with a mean weight of 76 (+/-18) kg. Presence of IDH was lower during albumin sessions based on all definitions. The risk of hypotension was significantly decreased based on the KDOQI, decrease in systolic blood pressure (SBP)<30 and 20mmHg and a nadir<90mmHg definitions.
Conclusion
In hypoalbuminemic patients who need IHD, administration of albumin before dialysis results in fewer episodes of intradialytic hypotension. Albumin infusion may be of benefit to improve safety of IHD in high-risk patients
Intradialytic hypotension definition and frequency in NS and Albumin groups
| Term | Definition | Albumin | NS | P |
| Nadir90 | Min IHD SBP< 90 mmHg | 22 (17.7%) | 31 (24.8%) | 0.09 |
| Nadir100 | Min IHD SBP<100 mmHg | 55 (44.4%) | 56 (44.8%) | 0.92 |
| Fall20 | Pre-HD SBP-min IHD ≥ 20 | 44 (35.8%) | 59 (48.0%) | 0.02 |
| Fall30 | Pre-HD SBP-min IHD ≥ 30 | 29 (23.6%) | 40 (32.5%) | 0.04 |
| Fall20Nadir90 | Pre-HD SBP-min IHD ≥ 20 and min IHD SBP <90 | 4 (3.3%) | 14 (11.4%) | 0.01 |
| Fall30Nadir90 | Pre-HD SBP-min IHD ≥ 30 and min IHD SBP <90 | 3 (2.4%) | 9 (7.3%) | 0.09 |
| KDOQI | Pre-HD SBP-min IHD ≥ 20 and symptoms of cramping, headache, lightheadedness, vomiting, or chest pain during HD | 9 (7.3%) | 19 (15.4%) | 0.002 |
| HEMO | Fall in SBP resulting in intervention of UF reduction, blood flow reduction, or saline administration | 16 (12.9%) | 26 (20.8%) | 0.07 |
P values based on Generalized Estimating Equations to analyze the effect of albumin on hypotension outcome.