Background: Hemodialysis is complicated by a high incidence of intradialytic hypotension and disequilibrium symptoms caused by hypovolemia and a decrease in extracellular osmolarity. Automatic adaptive system dialysis (AASD) is a proprietary dialysis system that provides automated elaboration of dialysate and ultrafiltration profiles based on the prescribed decrease in body weight and sodium content. Study Design: A noncontrolled (single arm), multicenter, prospective, clinical trial. Setting & Participants: 55 patients with intradialytic hypotension or disequilibrium syndrome in 15 dialysis units were studied over a 1-month interval using standard treatment (642 sessions) followed by 6 months using AASD (2,376 sessions). Intervention: AASD (bicarbonate dialysis with dialysate sodium concentration and ultrafiltration rate profiles determined by the automated procedure). Outcomes: Primary and major secondary outcomes were the frequency of intradialytic hypotension and symptoms (hypotensive events, headache, nausea, vomiting, and cramps), respectively. Results: More stable intradialytic systolic and diastolic blood pressures with lower heart rate were found using AASD compared with standard treatment. Sessions complicated by hypotension decreased from 58.7% +/- 7.3% to 0.9% +/- 0.6% (P < 0.001). The incidence of other disequilibrium syndrome symptoms was lower in patients receiving AASD. There were no differences in end-session body weight, interdialytic weight gain, or presession natremia between the standard and AASD treatment periods. Limitations: A noncontrolled (single arm) study, no crossover from AASD to standard treatment. Conclusions: This study shows the long-term clinical efficacy of AASD for intradialytic hypotension and disequilibrium symptoms in a large number of patients and dialysis sessions. Am J Kidney Dis. 58(1):93-100. (C) 2011 by the National Kidney Foundation, Inc.
|Autori interni:||PANICHI, VINCENZO|
|Autori:||Coli L; La Manna G; Comai G; Ursino M; Ricci D; Piccari M; Locatelli F; Di Filippo S; Cristinelli L; Bacchi M; Balducci A; Aucella F; Panichi V; Ferrandello FP; Tarchini R; Lambertini D; Mura C; Marinangeli G; Di Loreto E; Quarello F; Forneris G; Tancredi M; Morosetti M; Palombo G; Di Luca M; Martello M; Emiliani G; Bellazzi R; Stefoni S|
|Titolo:||Automatic Adaptive System Dialysis for Hemodialysis-Associated Hypotension and Intolerance: A Noncontrolled Multicenter Trial|
|Anno del prodotto:||2011|
|Digital Object Identifier (DOI):||10.1053/j.ajkd.2011.01.030|
|Appare nelle tipologie:||1.1 Articolo in rivista|