Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorALVARES, Valeria R. C.
dc.contributor.authorRAMOS, Camila D.
dc.contributor.authorPEREIRA, Benedito J.
dc.contributor.authorPINTO, Ana Lucia
dc.contributor.authorMOYSES, Rosa M. A.
dc.contributor.authorGUALANO, Bruno
dc.contributor.authorELIAS, Rosilene M.
dc.date.accessioned2017-08-17T19:21:27Z
dc.date.available2017-08-17T19:21:27Z
dc.date.issued2017
dc.description.abstractBackground: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. Methods: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) >= 20 mm Hg. Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone. Conclusion: Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal. (C) 2017 S. Karger AG, Basel
dc.description.indexMEDLINE
dc.identifier.citationAMERICAN JOURNAL OF NEPHROLOGY, v.45, n.5, p.409-416, 2017
dc.identifier.doi10.1159/000471513
dc.identifier.eissn1421-9670
dc.identifier.issn0250-8095
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/21501
dc.language.isoeng
dc.publisherKARGER
dc.relation.ispartofAmerican Journal of Nephrology
dc.rightsrestrictedAccess
dc.rights.holderCopyright KARGER
dc.subjectEnd-stage renal disease
dc.subjectBlood pressure
dc.subjectCicloergometry
dc.subjectPhosphate
dc.subjectHemodynamic
dc.subject.otherhemodialysis-patients
dc.subject.otherphosphate removal
dc.subject.otherdialysis
dc.subject.othermortality
dc.subject.otherdevices
dc.subject.othervolume
dc.subject.otherprevention
dc.subject.othermanagement
dc.subject.wosUrology & Nephrology
dc.titlePneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus13
hcfmusp.contributor.author-fmusphcVALERIA REGINA DE CRISTO ALVARES
hcfmusp.contributor.author-fmusphcCAMILA DOSSE RAMOS DOS SANTOS
hcfmusp.contributor.author-fmusphcBENEDITO JORGE PEREIRA
hcfmusp.contributor.author-fmusphcANA LUCIA DE SA PINTO
hcfmusp.contributor.author-fmusphcROSA MARIA AFFONSO MOYSES
hcfmusp.contributor.author-fmusphcBRUNO GUALANO
hcfmusp.contributor.author-fmusphcROSILENE MOTTA ELIAS
hcfmusp.description.beginpage409
hcfmusp.description.endpage416
hcfmusp.description.issue5
hcfmusp.description.volume45
hcfmusp.origemWOS
hcfmusp.origem.pubmed28407637
hcfmusp.origem.scopus2-s2.0-85017694237
hcfmusp.origem.wosWOS:000401805100005
hcfmusp.publisher.cityBASEL
hcfmusp.publisher.countrySWITZERLAND
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