Intradialytic Hypotension Clinical Trial
Official title:
The Effect of Head Out Water Immersion During Dialysis on Clinical Parameters, Hemodynamic Parameters, and Hormonal Parameters in 10 Hemodialysis Patients
Immersion to the neck before and during hemodialysis session may increase intravascular
volume, potentiate the ability to ultrafiltrate excess water, with less symptoms of shock,
muscle crumps etc.
The aim of the present study is to compare blood volume, hemodynamic and endocrine
parameters of chronic ESRD patients undergoing forth dialysis session in water immersion vs.
control regular session.
10 chronic hemodialysis patients, treated in the hemodialysis unit of Asaf-Harofeh Medical
Center will be enrolled in the study.
Hemoglobin and albumin will be detected at baseline, and a recent (less than one year) echo
will be used for the detection of ejection fraction.
The study will be a cross over study. Each set of studies will consist of two dialysis
sessions, an immersion session, and a dry, non-immersion session. The study sessions will be
short, 3 hours sessions with 250-350 ml/min blood flow (depends on the patients access)
dialysate flow was 500 ml/min and dialysate sodium was 137meq/l. The temperature of the
dialysate will be adjusted to 37°C and its composition as follows: Na+ = 137 mEq/L, K+ = 2.0
mEq/L, Ca2+ = 3.0 mEq/L, Mg2+ = 1.0 mEq/L, HCO3-= 30 mEq/L, glucose =100 mg/dL, CH3COO-= 8
mEq/L. The sodium concentration will be constant during treatment.
Ultrafiltration will be determined as the mean of UF during the ten previous sessions±10%
according to the patients weight on admission. The immersed and dry session will be done in
the midweek sessions, in random order, at least one week apart from each other.
Head-Out Water Immersion
A bath will be used for immersion. The bath will be filled with purified water before each
of the session, and will be heated to 34-35°C. Patients will enter the bath and sat upright
for few minutes and then connected to dialysis. The water will circulate through a
thermostats and heating device in order to maintain a constant temperature.
Patients with arterio-venous fistula or graft in their arm will be immersed in water up to
their axilla, with their arm lining on a floating pad. For patients with perm-cath immersion
will only be done up to 5 cm below the catheter insertion.
Study procedure
Subjects will enter the bath and sit for few minutes, after which blood samples will be
drown for baseline measurement. During the session blood pressure and heart rate will be
measured every 15 minutes by conventional sphygmomanometry. and blood volume will be
estimated by using blood volume monitor (Crit-Line).
Blood samples will be drown at baseline and after one hour, and before caseation of the
session for plasma renin activity, aldosterone, atrial natriuretic peptide. Baseline and end
of session urea will also measured for URR.
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