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Am J Kidney Dis. 2011 Jul;58(1):93-100. doi: 10.1053/j.ajkd.2011.01.030. Epub 2011 May 20.

Automatic adaptive system dialysis for hemodialysis-associated hypotension and intolerance: a noncontrolled multicenter trial.

Author information

1
U.O. di Nefrologia, Dialisi e Trapianto, Policlinico S. Orsola, Bologna, Italy.

Abstract

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.

PMID:
21601329
DOI:
10.1053/j.ajkd.2011.01.030
[Indexed for MEDLINE]

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