PNEUMATIC COMPRESSION DEVICES IN THE PREVENTION OF INTRADIALYTIC HYPOTENSION

M DANG1*, C SB SIA1*, K WONG1,

1Department of Nephrology, Peninsula Health, 2 Hastings Road, Frankston, Victoria, Australia

*Co-first author

Aim: To determine the effect of pneumatic compression devices (PCDs) on intradialytic hypotension (IDH) in high-risk patients.

Background: IDH is a common problem during haemodialysis (HD) and is associated with increased mortality and morbidity. Its pathophysiology in part relates decreased plasma volume associated with ultrafiltration. PCDs increase blood flow and venous return from the lower limbs and may decrease the frequency of IDH.

Methods: This study was a two-period, eighteen-treatment, crossover trial. HD patients at high risk of IDH were recruited. Patients underwent eighteen HD sessions, randomised to begin the first nine sessions either with or without PCDs. The primary outcome was the incidence of IDH, which was defined as a drop in intradialytic systolic blood pressure (SBP) from pre-dialysis SBP by at least 20 mmHg. Secondary outcomes were IDH with patient symptoms requiring intervention, nadir SBP, absolute maximum drop in SBP, nadir SBP less than 100 mmHg, nadir SBP less than 90 mmHg and fluid removal. A post-study interview was conducted to determine patient comfort levels on dialysis.

Results: 136 dialysis sessions with PCDs and 144 control dialysis sessions in 16 patients were performed. There was no statistically significant difference in the incidence of IDH between dialysis sessions with PCDs and control sessions (58% versus 52%, P-value = 0.31). All secondary outcomes were not statistically significantly different between two arms (all P-values > 0.05). With PCDs, patient comfort on dialysis was improved in 81.3% (13/16) and made no difference in 18.8% (3/16).

Conclusion: PCDs had no effect on IDH. PCDs improved patient comfort on dialysis in the majority of patients.

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