Hemodynamic response to orthostatic stress immediately after dialysis session in chronic hemodialysis patients

Abstract

Abstract Orthostatic hypotension is a risk factor for falls among chronic hemodialysis (HD) patients. This study aimed to investigate the hemodynamic response to orthostatic stress immediately after an HD session. Twenty-one HD patients (mean age, 70.2 ± 8.1 years; HD duration, 7.5 ± 6.4 years) participated in this study. Each 5-min hemodynamic monitoring was performed in the supine, semi-recumbent, and sitting positions immediately after an HD session. Hemodynamic variables were measured using a noninvasive beat-to-beat monitoring device during the test. Patients were divided into an intradialytic hypotension (IDH) group and a non-IDH group according to the presence or absence of IDH on the day of the measurements, and intra- and intergroup comparisons were performed. In the IDH group, the nadir values of systolic blood pressure in the semi-recumbent and sitting positions were significantly lower than those in the supine position and the last systolic blood pressure in the semi-recumbent position. The nadir of stroke volume in the sitting position was significantly lower than that in the supine position. There were no statistically significant intergroup differences in the changes for any positions. These results suggest that patients with IDH require special attention when getting out of bed to prevent post-dialytic falls.

Keywords

• Hemodialysis
• Hypotension
• Noninvasive continuous hemodynamic monitoring
• Postural change