Browsing by Subject "Intradialytic hypotension"

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    Feeding during dialysis-risks and uncertainties
    (Oxford University Press, 2018-06-01) Agarwal, Rajiv; Georgianos, Panagiotis; Medicine, School of Medicine
    Allowing dialysis patients to eat during the treatment is controversial. It is, therefore, no surprise that practices and policies with respect to intradialytic food consumption vary considerably from unit to unit and from country to country. Those who defend the position of feeding during dialysis reason that intradialytic meals offer a supervised and effective therapy for protein-energy wasting. Those who take the opposite view argue that intradialytic food intake should be avoided for the following three reasons. First, interventional studies show that eating during dialysis causes a clinically significant reduction in systemic blood pressure during the postprandial period and elevates the risk of symptomatic intradialytic hypotension; the latter is associated with increased mortality risk. Second, clinical studies have shown that eating during dialysis interferes with the adequacy of the delivered dialysis, whereas eating 2-3 h before the dialysis session has no impact on the efficiency of the subsequent dialysis treatment. And third, randomized studies show that eating during dialysis focus on the positive outcomes but do not adequately balance this potential benefit against the risk of intradialytic hemodynamic instability and poor quality of delivered dialysis. Even after half a century of providing long-term dialysis, definitive randomized trials that balance risks and benefits of eating during dialysis are missing. These knowledge gaps require randomized trials. Since there is a real possibility of harm with eating during dialysis, we caution that instead of encouraging the widespread use of intradialytic meals, practices and policies should focus on adequate nutrient intake during the interdialytic interval.
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    Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis
    (Elsevier, 2019-03) Choi, Mun Sun; Kistler, Brandon; Wiese, Gretchen N.; Stremke, Elizabeth R.; Wright, Amy J.; Moorthi, Ranjani N.; Moe, Sharon M.; Hill Gallant, Kathleen M.; Medicine, School of Medicine
    Objective Hemodialysis (HD) patients have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of hemodialysis treatment; but, eating during HD may be discouraged due to concerns of postprandial hypotension. However, little data is available to support this practice. In this study, we hypothesized that high protein meals during HD does not lead to symptomatic intradialytic hypotension events. Design A 9-week, non-randomized, parallel-arm study. Setting A single in-center HD clinic. Subjects 18 HD patients from two shifts completed the study. Patients were 62±16 years-old in age with dialysis vintage 3.4±2.6 years. Intervention The intervention group (n=9) received meals of ~30g protein and ~1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid for hemodialysis patients during dialysis for 25 consecutive HD sessions. The control group (n=9) completed all aspects of the study including a visit by study personnel but were not given meals. The 25 consecutive sessions prior to the start of the intervention/control phase were used as a baseline comparison for each patient. Main Outcome Measure Symptomatic hypotension event frequency. Results In the intervention arm, there were 19 symptomatic hypotension events in 5 patients pre-study and 18 events in 6 patients during the study. In the control arm, there were 16 events in 7 patients pre-study and 13 events in 7 patients during the study. Change in the frequency of symptomatic hypotension events from pre-study to during study was not different between groups (P=0.71). There was no effect of meals on nutritional status, but patients reported positive attitudes towards receiving meals during dialysis. Conclusion High-protein meals during HD did not increase symptomatic hypotension events. Larger, longer-term studies are needed to confirm these results and evaluate whether high-protein meals on dialysis benefit nutritional status and clinical outcomes.