Abstract: SA-PO411
Pharmacologic and Nonpharmacologic Management of Intradialytic Hypotension in ESKD: A Systematic Review and Meta-Analysis
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Menghrajani, Rajiv Hans Solita, Lincoln Medical Center, Bronx, New York, United States
- Almanzar, Mirtha Camila, Lincoln Medical Center, Bronx, New York, United States
- Matabang, Maria Angela, Lincoln Medical Center, Bronx, New York, United States
- Gumabon, Kevin Elissandro, Philippine General Hospital, Manila, Metro Manila, Philippines
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Lerma, Edgar V., University of Illinois Chicago College of Medicine, Chicago, Illinois, United States
Background
Although life-saving, hemodialysis has many complications, intradialytic hypotension (IDH) being one of most frequently recognized occurring in ~10-12% of treatments. In this study, we aim to establish the efficacy of available strategies in managing IDH in end-stage kidney disease (ESKD) patients on hemodialysis (HD) or hemodiafiltration (HDF).
Methods
Electronic databases were searched up to March 2024. Three reviewers independently screened the abstracts, reviewed full-text papers, and critically appraised the quality of included studies using PRISMA guidelines. The primary outcome is the frequency of IDH per hemodialysis session among identified pharmacologic and non-pharmacologic interventions.
Results
Out of 412 articles retrieved, 17 randomized trials were included in a systematic review, 6 of which evaluated pharmacologic while 11 evaluated non-pharmacologic interventions. Of the 17 studies, 8 were included in the meta-analysis (n=745 patients, N=80, 093 dialysis sessions). Pharmacologic interventions (fludrocortisone, mannitol, levocarnitine) showed a significant decrease in IDH frequency [RR 0.40, p < 0.00001 95% CI: 0.17 - 0.92]. However, non-pharmacologic interventions (bicarbonate in HD solution, citrate in HD solution ultrafiltration (UF) profiling, body composition monitoring, UF biofeedback) did not significantly decrease IDH frequency [RR 0.93, p= 0.34 95% CI: 0.81 - 1.08]. Both groups had significant heterogeneity, with I2 = 90% and I2 = 89%, respectively.
Conclusion
Pharmacologic interventions lessened the frequency of IDH among ESKD patients on HD or HDF. However, larger randomized trials with more patients and HD sessions are needed to firmly establish its effect.
Forest Plot Forest Plot showing the effects of Non-Pharmacologic Interventions on Frequency of IDH
Forest Plot showing the effects of Pharmacologic Interventions on Frequency of IDH