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      Evaluación de la utilidad de la monitorización continua de la presión arterial mediante la función HASTE en los pacientes en hemodiálisis Translated title: Evaluation of the continous monitoring of blood pressure by the HASTE function in patients under haemodyalisis

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          Abstract

          La hemodiálisis puede generar inestabilidad hemodinámica, desencadenando episodios de hipotensión, algunos sintomáticos. La función HASTE del monitor Colin, permite la monitorización no invasiva y continuada de la TA mediante un algoritmo de cálculo, para el cual precisa la señal del ECG y la onda de saturación de O2. Con los objetivos de validar la toma de TA mediante el monitor Colin y demostrar la capacidad de detección de hipotensión presintomática mediante la función HASTE, se realiza un estudio descriptivo longitudinal, durante 4 semanas. Para validar el monitor Colin se comparó la TA tomada cada 30 minutos en pacientes en HD con el monitor y con el método convencional (aparato de tensión automática). Para demostrar la capacidad de detección de hipotensión presintomática mediante la función HASTE y la disminución de hipotensión sintomática mediante una actuación precoz, elegimos pacientes que presentaban una TA inferior o igual a100 / 50 mmHg en un 30 % de las HD efectuadas durante los 2 meses previos. Se hallaron 57 episodios de hipotensión sintomática, 27 episodios en el período convencional y 30 episodios durante el período Colin, sin hallarse diferencias estadísticamente significativas entre ambos métodos. Las hipotensiones sintomáticas durante el período Colin tienen una media TA sistólica 91,03 mmHg y TA diastólica de 51,1 mmHg. Con el método convencional se registraron 237 medidas de TA sistólica inferiores a los límites establecidos, con una media de 89,09 mmHg y 87 medidas de TA diastólica con una media de 45,36 mmHg. Por tanto, no hay diferencia estadística significativa en la toma de la TA entre ambos aparatos y se observan más número de registros de TA por debajo de los límites establecidos en el período Colin por la monitorización continua a través de la función HASTE. Las hipotensiones sintomáticas registradas durante el período convencional son más acusadas requiriendo un mayor número de intervenciones de enfermería.

          Translated abstract

          HAEMODYALISIS can produce episodes of haemodinamic instability leading to symptomatic episodes of hypotension. The HASTE function ofthe Colin monitor allows the non invasive monitoring of blood preassure using an algorithm that needs a precise ECG signal and the O2 saturation wave. To validate the measurements of blood preasureusing the Colin monitor and to demonstrate its capacity to detect pre-symptomatic hypotensionusing the HASTE function, we performed a longitudinal descriptive study over 4 weeks. To validate the Colin monitor we compared the blood pressure measured every 30 minutes with the monitor and with a conventional method. To demonstrate the capacity of detection of presymptomatic hypotension, we selected a groupof patients with blood pressure equal or inferior to100/50 mmHg (30% of patients in the previous two months). We detected 57 episodes of symptomatic hypotension (27 in the conventional period and 30 during the Colin period). There were no stastistically significant differences. In conclusion, there are no statistically significant differences in the blood pressure measured by the two methods. The number of registers of blood pressure during the Colin period is under the thresold when the HASTE function is used.Symptomatic hypotensions during the conventional period are more pronounced and require more interventions from the nursing team.

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          The role of blood volume reduction in the genesis of intradialytic hypotension.

          The aim of this multicenter prospective study was to investigate the role of relative blood volume (RBV) reduction on intradialytic hypotension. One hundred twenty-three patients on chronic hemodialysis therapy were considered a priori normotensive (reference group A), intradialytic hypotension prone (group B), and hypertensive (group C). RBV was continuously monitored, and diastolic and systolic blood pressure (SBP) and heart rate (HR) were measured at 20-minute intervals during three dialysis sessions. Intradialytic RBV reduction was -13.8% +/- 7.0% and similar in the three groups (P = 0.841). SBP and RBV decreased during dialysis, with a sharp initial decrease (in the first 20 minutes for SBP and the first 40 minutes for RBV), followed by a slower decrease. The lying bradycardic response before dialysis was less in group B than group A (a decrease of 3 +/- 7 versus 9 +/- 9 beats/min; P < 0.001). When symptomatic hypotension occurred, RBV reduction was not significantly different from that recorded at the same time during hypotension-free sessions (-13.9% +/- 6.4% versus -12.7% +/- 5.2%; P = 0.149). Group, baseline plasma-dialysate sodium gradient, RBV line irregularity, and early RBV and HR reduction during dialysis influenced the relative risk for symptomatic hypotension with a sensitivity of 80% versus 30% for RBV alone. We found no difference in reduction in RBV in the three groups and no critical RBV level for the appearance of symptomatic hypotension. With variables easily available within 40 minutes of dialysis, RBV monitoring increases the prediction of symptomatic hypotension. Copyright 2002 by the National Kidney Foundation, Inc.
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            Dialysate calcium profiling during hemodialysis: use and clinical implications.

            Low dialysate calcium (LdCa) concentration is used to prevent or treat hemodialysis (HD)-induced hypercalcemia, but its use has been complicated by intradialytic hypotension in some patients. Our goal was to explore the possibility that dialysis calcium profiling (dCaP) can ameliorate intradialytic hypotension in HD patients who need to have dialysis performed with LdCa. In a randomized crossover design, eighteen HD patients underwent one four-hour HD session with LdCa of 1.25 mmol/L (LdCa group) and one four-hour HD session with LdCa of 1.25 mmol/L during the first two hours and high dCa of 1.75 mmol/L during the remaining two hours (dCaP group). After that, they underwent another four-hour HD session with medium dCa of 1.5 mmol/L (MdCa group). Before HD and at four 60-minute intervals during the HD sessions, blood pressure (BP), heart rate (HR) and noninvasive measurements of cardiac index (CI), using bioelectrical impedance, were obtained. Ionized serum calcium (iCa) also was measured before HD and at 120 and 240 minutes into the HD session. In a separate study, eight HD patients were treated for three weeks with 1.25 mmol/L dCa and three weeks with the dCaP technique described above, in random order. A three-week treatment with MdCa followed. BP and symptoms were recorded during each HD session. During the LdCa treatment the iCa values remained unchanged, whereas mean arterial pressure (MAP) and CI decreased by 16.5 +/- 8.3% and 14.2 +/- 14.6%, respectively, at the end of HD. During the first half of the dCaP treatment, iCa, MAP and CI decreased by 2.2 +/- 4.1%, 12.6 +/- 12.3%, and 9.6 +/- 13.4%, respectively, whereas during the second half of the same treatment, iCa, MAP and CI values increased by 10.2 +/- 3.3%, 7.8 +/- 7.2% and 10.8 +/- 9.1%, respectively, from the middle HD values. ANOVA showed that the time x treatment effect was significant for iCa, MAP and CI. Total peripheral resistance and HR changes were insignificant and similar among treatments. Hemodynamic effects were comparable between LdCa and MdCa treatments. Intradialytic events were reduced (P < 0.05) only with the dCaP treatment. The drop in BP observed during the last two hours of HD in both the LdCa and MdCa groups was abolished in the dCaP group. The latter was accomplished via an increase in cardiac output, due to an iCa-induced increase in myocardial contractility. Therefore, dCaP, by individualizing the dCa concentrations used and timing the switching between them, may improve intradialytic BP instability and simultaneously minimize the risk for HD patients to develop hypercalcemia.
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              Blood Volume Control by Biofeedback and Dialysis-Induced Symptomatology

              In earlier studies, a reduction in intradialytic procedures was observed in patients with severe intradialytic hypotension symptomatology by the use of blood volume controlled biofeedback systems. However, few data are present on the use of biofeedback-controlled treatments in patients experiencing minor intradialytic symptoms. In the present study, 157 standard and 158 biofeedback-controlled treatments were compared during a 2-month period in 16 hemodialysis patients. Both the percentage of hypotensive episodes (6.3 ± 11.3 vs. 15.8 ± 18.3%; p < 0.05) as well as other intradialytic symptoms (cramps, nausea, headache, abdominal pain) (11.0 ± 12.8 vs. 18.1 ± 16.9%; p < 0.05) were significantly less during biofeedback-controlled treatments compared to standard dialysis treatments, despite a similar decline in relative blood volume (8.8 ± 3.5 vs. 8.3 ± 3.1%; p = n.s.). Interdialytic weight gain and intradialytic rise in plasma sodium levels were comparable. Concluding, in this short-term preliminary study, blood volume controlled biofeedback improved dialysis tolerance also in patients with minor intradialytic symptomatology.
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                Author and article information

                Contributors
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                Journal
                nefro
                Revista de la Sociedad Española de Enfermería Nefrológica
                Rev Soc Esp Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (, , Spain )
                1139-1375
                April 2004
                : 7
                : 2
                : 10-15
                Affiliations
                [01] Sabadell Barcelona orgnameHospital Parc Taulí orgdiv1Servicio de Nefrología
                Article
                S1139-13752004000200003
                10.4321/s1139-13752004000200003
                eaf522bd-bd69-4876-a5f3-da65246416a1

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 6
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                Hemodiálisis,Hipotensión,Función HASTE,Monitorización continua no invasiva,Detección precoz,Hemodialysis,Hypotension,HASTE function,Continous non-invasive monotorization,Early detection

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