Profiled hemodialysis: A new approach for intradialytic symptomatic hypotension

In the last 10 years the percentage of dialysis patients presenting intradialytic hypotension has greatly increased in spite of the large-scale use of extracorporal techniques as alternative to standard hemodialysis (SHD); this is due to the increasing mean age and percentage of cardiovascular and diabetic patients. Profiled hemodialysis (PHD) is a new technique for the treatment of intradialytic symptomatic hypotension. It is based on the intradialytic modulation of the dialysate sodium concentration according to a profile elaborated by a new mathematical kinetic model. The aim of the PHD is to maintain blood volume above the individual patient's critical level, thanks to the dialysate sodium profile, by reducing the decrease in plasma osmolarity and boosting intravascular fluid refilling. This work aims to clinically validate the PHD technique by testing its ability to maintain a more stable intradialytic blood volume, mean blood pressure, heart rate and cardiovascular function in comparison with SHD. Twelve dialysis patients on SHD treatment were chosen because of their intradialytic hypotension. Twelve SHD (one per patient) and 12 PHD (one per patient) sessions were performed in order to reach the same sodium mass removal and body weight decrease both on PHD and SHD. During these sessions we monitored blood volume variation % by the crit line, mean blood pressure and heart rate directly and stroke volume and cardiac output indirectly by bidimensional doppler-echocardiography. Comparison between the two techniques shows PHD to achieve a significantly more stable blood volume, blood pressure and cardiovascular function than SHD, in particular during the second and the third hour of the dialysis session.