Original InvestigationDialysisAutomatic Adaptive System Dialysis for Hemodialysis-Associated Hypotension and Intolerance: A Noncontrolled Multicenter Trial
Section snippets
Setting and Participants
The study was a noncontrolled (single arm) multicenter prospective clinical trial evaluating a group of patients receiving standard hemodialysis or hemodiafiltration (treatment at baseline) and presenting with dialysis intolerance. Patients were monitored for 1 month using the treatment they were receiving at baseline (the run-in phase) followed by a 6-month treatment with AASD divided into two 3-month periods.
Patients selected for the study had intradialytic hypotension or disequilibrium
Results
An Italian noncontrolled multicenter (15 dialysis units) prospective clinical trial was carried out from September 2007 to September 2008 to confirm the clinical efficacy of AASD in the long term (6 months) in 55 patients during 2,376 dialysis sessions.
Patients were all older than 18 years and at baseline had been undergoing hemodialysis 3 times a week for at least 6 months. Patient and dialysis session characteristics are listed in Table 1.
Seven patients dropped out of the study: 1 patient
Discussion
The pathogenesis of intradialytic complications is multifactorial. The main factor is plasma water loss through ultrafiltration, with a decrease in extracellular space and blood volume. The decrease in intradialytic osmolarity causes an additional loss of plasma water due to the shift from the extracellular to the intracellular space.11 The extracellular space decrease induces hypotension, whereas the intracellular space increase induces disequilibrium symptoms.3, 12, 13 Many investigators
Acknowledgements
Support: The study was supported in part by the Fondazione Cassa di Risparmio in Bologna, project no. 2007/0234 “Innovazioni diagnostiche e terapeutiche nell'approccio alle criticità immunologiche del paziente nel percorso Dialisi-Trapianto di Rene” (Principal Investigator, Prof Stefoni).
Financial Disclosure: The authors declare that they have no relevant financial interests.
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Cited by (33)
Why is Intradialytic Hypotension the Commonest Complication of Outpatient Dialysis Treatments?
2023, Kidney International ReportsCitation Excerpt :However, as patients consume different amounts of sodium and have different interdialytic weight gains, this has led to the concept of an individual osmostat.92,93 Individualizing the dialysate sodium concentration according to the plasma sodium, so that delivering an iso-natric dialysate has been reported to reduce the incidence of IDH, but this technology requires further refinement and clinical testing.94 Plasma potassium declines rapidly during the early phase of dialysis, predominantly by diffusion and then plateaus.
Effects of Caffeinated and Decaffeinated Coffee on Hemodialysis-Related Headache (CoffeeHD): A Randomized Multicenter Clinical Trial
2021, Journal of Renal NutritionCitation Excerpt :Controlling the ultrafiltration rate has indeed been shown to decrease IDH and even mortality.31,32 Several interventions have been tested to minimize IDH and headache like the automatic adaptive system dialysis and the feedback control of blood volume.33,34 Second, our results showed a beneficial effect of coffee intake on reducing IDH in non-hypertensive patients, although close to significance.
Isolated Effects of Renal Failure, Anthropometric Indices, and Serum Total Iron-Binding Capacity as Determinants of Muscle Performance in Hemodialysis Patients
2016, Journal of Renal NutritionCitation Excerpt :Serum total iron-binding capacity (TIBC) (reflecting transferrin) gained attention as prognostic inflammation-malnutrition marker in ESRD patients9; however, its association with physical performance is not known. Living with renal replacement therapy in the current era may benefit from significant improvements in therapies such as online convective treatments (hemodiafiltration),10 usage of high-flux hemodialysis membranes,11 improved treatments of chronic kidney disease-mineral bone disease,12,13 and automated ultrafiltration profiling,14 to name a few. With these improvements, survival is prolonging and vintage above 3 or even 4 decades on dialysis is very well possible.15
Feedback control in hemodialysis
2023, Seminars in DialysisChoices in hemodialysis therapies: Variants, personalized therapy and application of evidence-based medicine
2021, Clinical Kidney JournalSodium and ultrafiltration profiling in hemodialysis: A long-forgotten issue revisited
2021, Hemodialysis International
Originally published online May 23, 2011.
Trial registration: www.ClinicalTrials.gov; study number: NCT01241994.