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MILITARY HOSPITAL 17

EVALUATION OF INTRADIALYTIC

HYPOTENSIVE COMPLICATION IN CHRONIC

RENAL FAILURE PATIENTS

Nurse. Tran Huu Nhut

Doctor. Tran Cong Loc

INTRODUCTION

• Viet Nam: about 5,4 millions of CKD, making up 6,73% of

population and of these 72,000 require hemodialysis (HD) but

only 10% were dialysed.

• HD is one of the most effective and modern renal replacement

therapies that CRF patients can’t miss.

• However, HD is accompanied by several complications. In the

past: due to the technical drawbacks associated with the dialysis

machines and water systems. Nowaday: hypotension (20-50%)

• The complication effects quality of HD, even fatality

• Hypotension is a great interest now.

Objectives

1. To identify rate of intradialytic hypotension in

chronic renal failure patients with IIIb and IV

stage.

2. To study some risk factors of intradialytic

hypotension.

OVERVIEW

Artificial kidney system

OVERVIEW

• According to Bregman and colleagues, hypotension is

a common complication

– Hypotension: 20-30%

– Cramps: 5-20%

– Nausea and vomiting: 5-15%

– Headache: 5%

– Chest pain: 2-5%

– Back pain: 2-5%

– Itching: 5%

– Fever, chills, infection: < 1%

OBJECTS AND METHODS

Objects and criterias

• Objects

70 patients were diagnosed IIIb or IV stage CRF,

indicated maintenance hemodialysis.

• Criterias

- > 16 years old

- Indicated IIIb or IV stage CRF (according to

Nguyen Van Xang criteria)

- Consent of patients.

• Exclusion criterias

- Psychiatric and confused patients can’t answer

investigative questions.

- Hypotension occurs prior to hemodialysis.

• Study time and location

- Time: From June to August, 2014.

- Location: Department of Hemodialysis, Da Nang

general hospital and ICU, Military hospital 17.

Method

Research design : prospective, cross-sectional description.

Methodology

Patient preparation:

• Ask history, exam clinically

• Weight (between 2 HD sessions, before and after of

HD)

+ Heart rate: before, during and after HD. During HD: every

30 minutes.

+ Blood pressure: measure prior to HD 10 minutes and during

HD at: starting HD, 30, 60, 120 minutes,….ending HD and

at anytime patients have symptoms of hypotension.

Materials

• B.Braun Dialysis machine (Germany), Gambro and

Nipro Dialysis machine (Japan) with automatic

hemofiltration control system.

• GE Osmonics RO system for hemodialysis (USA).

• Nikko sphygmomanometer and stethoscope (Japan).

• Tanita scale (Japan)

Evaluation methods

Diagnostic criteria of intradialytic hypotension: According to

Emili and colleagues

• Decrease in systolic BP by ≥10mmHg compared with pre-

dialysis BP and associated with symptoms as dizziness, nausea

and vomiting, sweating, convulsion, delirium, confusion…

• Decrease in systolic BP by ≥ 10mmHg with pre-dialysis BP <

100mmHg

• Systolic BP <100mmHg with pre-dialysis BP <150 mmHg.

• Systolic BP < 110mmHg with pre-dialysis BP >150 mmHg.

Research variables

• Demographic characteristics

- Age, gender

• Intradialytic hypotension

- Hypotensive rate

- Hypotensive time

• Risk factors of intradialytic hypotension

- Age, dialysis period, weight gain between 2 sessions

Data analysis

• Epi Info 6.0.

RESULTS AND DISCUSSION

Age data

Nguyễn Cao Luận and colleagues (51-60 years old: 32%)

Age (year) Number of pts (n) Rate (%)

≤ 30 10 14,3

31 - 40 9 12,8

41 - 50 16 23,0

51 - 60 18 25,7

> 60 17 24,2

Total 70 100

Gender data

46%54%

Female

Male

Nguyễn Cao Luận (male52%, female 48%)

Hypotensive rate

Hypotensive rate of patients

ComplicationNumber of

patients

Total of

patients (n)Rate (%)

Hypotension 17 70 24

Hypotensive rate of dialysis times

Complication

Total of

hypotensive

times

Total of

hemodialysis

times

Rate (%)

Hypotension 84 1640 5,1

Chu Thị Dự : 38%, Bregman H và Daugirdas JT : 20-30%

Cù Tuyết Anh: 8,8%. Hoàng Quang Trung : 5,8%

Hypotensive times

Hypotensive

times

Number of

hypotensionRate (%) p

First 60 minutes 5 6,0 < 0,05

Second hour 12 14,3 < 0,05

Third hour 23 27,4 < 0,05

Fourth hour 44 52,3 < 0,05

Total 84 100

Cao Tấn Phước :142.57±47.39 (third hour)

Cù Tuyết Anh: the fourth hour: 27,6%.

Risk factors of intradialytic hypotension

Age

Age

(year)

Total of

patients

Number of

HD times

Number of

hypotension

Hypotensive

rate (%)p

1 < 30 10 232 6 2,6

2 31 - 40 14 328 16 4,9

3 41 - 50 16 376 22 5,8

4 51 - 60 18 424 21 4,9

5 > 60 12 280 19 6,8 p(1&5<0,05)

Total 70 1640 84 5,1

Nguyễn Minh Tuấn : 44% in patients ≥ 65 years old

Santoro: age > 60: 25%.

Dialysis period

Dialysis period

(month)

Total of

patients

Total of

dialysis

Number of

hypotension

Hypotensive

rate (%)p

1 - 6 10 232 15 6,4 > 0,05

7 - 12 6 136 6 4,4 > 0,05

13 - 36 26 616 32 5,2 > 0,05

37 - 60 17 400 16 4,0 > 0,05

> 60 11 256 15 5,8 > 0,05

Total 70 1640 84 5,1

Weight gain between 2 sessions

Weight gain

between 2 sessions

Total of

dialysis

Number of

hypotension

Hypotensive

rate (%)p

1 < 1,0kg 30 1 3,3

2 1,0 – 2,0kg 275 7 2,5

3 2,1 – 3,0 kg 743 41 5,5

4 > 3,0 kg 592 35 5,9 p(2&4<0,05)

Total 1640 84 5,1

Cù Tuyết Anh : gain >4 kg: hypotensive rate is17,2%.

CONCLUSIONS

1. Intradialytic hypotensive rate and time:

- 17 patients had hypotension at least 1 time, making up 24%

- Number of hypotension was 84 times, making up 5,1%

- Hypotensive time: the fourth hour of dialysis process (p<0,05)

2. Risk factors of intradialytic hypotension:

- Age > 60: hypotensive rate was higher than group < 30 (p< 0,05)

- Weight gain between 2 sessions > 3kg: hypotensive rate was

higher than group of 1,0-2,0kg (p<0,05)

PROPOSAL

• Patients were consulted about risks, dangers of

hypotensive complication.

• Nurse should have suitable caring plans and reduce

complications during dialysis process.

• To control weight gain between dialysis sessions and

limit excessive weight gain between 2 sessions (not

exceed 1kg within 2 - 3 days).

• Nurse must record vital signs every 15 -30 minutes,

especially at the ending hour in dialysis process

THANK YOU !