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Kidney Week

Abstract: PO0895

The Use of Caffeine to Treat Intradialytic Hypotension

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Das, Indrani Guzman, Weill Cornell Medicine, New York, New York, United States
  • Rahim, Shab E Gul, NewYork-Presbyterian Healthcare System Inc, New York, New York, United States
  • Tummalapalli, Sri Lekha, Weill Cornell Medicine, New York, New York, United States
Introduction

Intradialytic hypotension (IDH) affects over 10% of individuals on hemodialysis (HD) and can cause long-term multisystem ischemic damage. One proposed mechanism for IDH is the accumulation of local adenosine causing vasodilation. Agents such as midodrine and caffeine counter these vasodilatory effects. Herein we present a case of IDH where the ingestion of caffeine prior to HD sessions significantly reduced the severity of IDH.

Case Description

A 77-year-old female with CKD-5, longstanding hypertension, and type 2 diabetes mellitus was admitted for initiation of HD. During her 1st HD session, she experienced IDH with a sudden drop in her systolic blood pressure (SBP) from the 193 to 113, accompanied by loss of consciousness and convulsions of the bilateral upper extremities. She regained consciousness without a postictal state and no significant changes on ECG. Echocardiography ruled out pericardial effusion. On subsequent HD sessions, the patient continued to experience IDH with average decreases of over 100mmHg in her SBP. Initial management by lowering blood flow rate, lowering dialysate temperature, and holding the patient’s pre-dialysis antihypertensive regimen had only a mild effect in preventing IDH. Given previous studies showing the efficacy of 250 mg caffeine capsules in preventing IDH, we tested the effect of caffeine on this patient’s IDH. 30 minutes prior to her next inpatient HD session, we administered 10 oz of coffee (150 mg of caffeine). Her drop in SBP during that session was markedly reduced from 187 to 149.

Discussion

Non-pharmacological measures to prevent IDH have previously been implemented but lack well-powered clinical trial evidence. Using coffee as a vehicle for caffeine administration was an effective preventive measure for IDH in our patient. We hypothesize that this effect is adenosine inhibition mediated. Adenosine is released by cells undergoing localized ischemia during HD, causing vasodilation. Studies show an increase of serum adenosine during IDH. Caffeine is a non-selective adenosine receptor antagonist, and can prevent sudden vasodilation during dialysis. Thus, coffee may be an effective alternative to midodrine for the prevention of IDH. In conclusion, coffee provided a readily available, inexpensive, patient-centered, non-pharmacological measure to reduce IDH while also decreasing the risk of polypharmacy.