The Effect of Cool Dialysate & Sodium Profiling on Hemodynamics in Patients with Intradialytic Hypotension

Lee, Young Jae; Han, Jae Joon; Ha, Sang Jin; Park, Mi Na; Moon, Ju Young; Jeong, Kyung Hwan; Lee, Sang Ho; Lee, Tae Won; Ihm, Chun Gyoo

Abstract

PURPOSE: There are methods to prevent intradialytic hypotension such as cool dialysate and sodium profiling but hemodynamic effects of these methods are not proved yet. We studied hemodynamic effects of cool dialysate and sodium profiling through brachial pulse monitoring which is simple and not invasive.
METHODS
Ten patients selected by single, blind, randomized study are enforced control phase, cool dialysate phase, and sodium profiling phase and checked brachial pulse for 10 minutes after dialysis and 10 minutes before finishing. Hemodynamics is checked by DynaPulse 5200A (Pulse metric, Inc. San Diego, CA, USA).
RESULTS
In control, central artery systolic blood pressure is decreased after dialysis. Brachial and central artery compliance is increased but brachial artery resistance is decreased. The central artery systolic pressure, brachial mean artery pressure, and brachial artery resistance is increased, but compliance is decreased in cool dialysate as compared with control dialysis. The comparison of intradialytic changes of hemodynamic parameters between control dialysis and sodium profiling shows that intradialytic changes of hemodynamic parameters are similar, but pre-hemodialytic weight is increased in sodium profiling. Number of episodes of symptomatic hypotension per dialysis treatment in cool dialysate and sodium profiling is decreased more than in control dialysis.
CONCLUSION
Our study suggests changes of compliance and resistance are most important in hemodynamic parameters of intradialytic hypotension, especially changes of compliance and resistance of vessel in cool dialysate are useful in preventing intradialytic hypotension.