ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-OR068

A Randomized Controlled Trial of Albumin Versus Saline for the Prevention of Intradialytic Hypotension in Hypoalbuminemic Patients

Session Information

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
TermDefinitionAlbuminNSP
Nadir90Min IHD SBP< 90 mmHg22 (17.7%)31 (24.8%)0.09
Nadir100Min IHD SBP<100 mmHg55 (44.4%)56 (44.8%)0.92
Fall20Pre-HD SBP-min IHD ≥ 2044 (35.8%)59 (48.0%)0.02
Fall30Pre-HD SBP-min IHD ≥ 3029 (23.6%)40 (32.5%)0.04
Fall20Nadir90Pre-HD SBP-min IHD ≥ 20 and min IHD SBP <904 (3.3%)14 (11.4%)0.01
Fall30Nadir90Pre-HD SBP-min IHD ≥ 30 and min IHD SBP <903 (2.4%)9 (7.3%)0.09
KDOQIPre-HD SBP-min IHD ≥ 20 and symptoms of cramping, headache, lightheadedness, vomiting, or chest pain during HD9 (7.3%)19 (15.4%)0.002
HEMOFall in SBP resulting in intervention of UF reduction, blood flow reduction, or saline administration16 (12.9%)26 (20.8%)0.07

P values based on Generalized Estimating Equations to analyze the effect of albumin on hypotension outcome.