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TRANSCRIPT
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MILITARY HOSPITAL 17
EVALUATION OF INTRADIALYTIC
HYPOTENSIVE COMPLICATION IN CHRONIC
RENAL FAILURE PATIENTS
Nurse. Tran Huu Nhut
Doctor. Tran Cong Loc
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INTRODUCTION
• Viet Nam: about 5,4 millions of CKD, making up 6,73% of
population and of these 72,000 require hemodialysis (HD) but
only 10% were dialysed.
• HD is one of the most effective and modern renal replacement
therapies that CRF patients can’t miss.
• However, HD is accompanied by several complications. In the
past: due to the technical drawbacks associated with the dialysis
machines and water systems. Nowaday: hypotension (20-50%)
• The complication effects quality of HD, even fatality
• Hypotension is a great interest now.
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Objectives
1. To identify rate of intradialytic hypotension in
chronic renal failure patients with IIIb and IV
stage.
2. To study some risk factors of intradialytic
hypotension.
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OVERVIEW
Artificial kidney system
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OVERVIEW
• According to Bregman and colleagues, hypotension is
a common complication
– Hypotension: 20-30%
– Cramps: 5-20%
– Nausea and vomiting: 5-15%
– Headache: 5%
– Chest pain: 2-5%
– Back pain: 2-5%
– Itching: 5%
– Fever, chills, infection: < 1%
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OBJECTS AND METHODS
Objects and criterias
• Objects
70 patients were diagnosed IIIb or IV stage CRF,
indicated maintenance hemodialysis.
• Criterias
- > 16 years old
- Indicated IIIb or IV stage CRF (according to
Nguyen Van Xang criteria)
- Consent of patients.
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• Exclusion criterias
- Psychiatric and confused patients can’t answer
investigative questions.
- Hypotension occurs prior to hemodialysis.
• Study time and location
- Time: From June to August, 2014.
- Location: Department of Hemodialysis, Da Nang
general hospital and ICU, Military hospital 17.
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Method
Research design : prospective, cross-sectional description.
Methodology
Patient preparation:
• Ask history, exam clinically
• Weight (between 2 HD sessions, before and after of
HD)
+ Heart rate: before, during and after HD. During HD: every
30 minutes.
+ Blood pressure: measure prior to HD 10 minutes and during
HD at: starting HD, 30, 60, 120 minutes,….ending HD and
at anytime patients have symptoms of hypotension.
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Materials
• B.Braun Dialysis machine (Germany), Gambro and
Nipro Dialysis machine (Japan) with automatic
hemofiltration control system.
• GE Osmonics RO system for hemodialysis (USA).
• Nikko sphygmomanometer and stethoscope (Japan).
• Tanita scale (Japan)
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Evaluation methods
Diagnostic criteria of intradialytic hypotension: According to
Emili and colleagues
• Decrease in systolic BP by ≥10mmHg compared with pre-
dialysis BP and associated with symptoms as dizziness, nausea
and vomiting, sweating, convulsion, delirium, confusion…
• Decrease in systolic BP by ≥ 10mmHg with pre-dialysis BP <
100mmHg
• Systolic BP <100mmHg with pre-dialysis BP <150 mmHg.
• Systolic BP < 110mmHg with pre-dialysis BP >150 mmHg.
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Research variables
• Demographic characteristics
- Age, gender
• Intradialytic hypotension
- Hypotensive rate
- Hypotensive time
• Risk factors of intradialytic hypotension
- Age, dialysis period, weight gain between 2 sessions
Data analysis
• Epi Info 6.0.
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RESULTS AND DISCUSSION
Age data
Nguyễn Cao Luận and colleagues (51-60 years old: 32%)
Age (year) Number of pts (n) Rate (%)
≤ 30 10 14,3
31 - 40 9 12,8
41 - 50 16 23,0
51 - 60 18 25,7
> 60 17 24,2
Total 70 100
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Gender data
46%54%
Female
Male
Nguyễn Cao Luận (male52%, female 48%)
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Hypotensive rate
Hypotensive rate of patients
ComplicationNumber of
patients
Total of
patients (n)Rate (%)
Hypotension 17 70 24
Hypotensive rate of dialysis times
Complication
Total of
hypotensive
times
Total of
hemodialysis
times
Rate (%)
Hypotension 84 1640 5,1
Chu Thị Dự : 38%, Bregman H và Daugirdas JT : 20-30%
Cù Tuyết Anh: 8,8%. Hoàng Quang Trung : 5,8%
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Hypotensive times
Hypotensive
times
Number of
hypotensionRate (%) p
First 60 minutes 5 6,0 < 0,05
Second hour 12 14,3 < 0,05
Third hour 23 27,4 < 0,05
Fourth hour 44 52,3 < 0,05
Total 84 100
Cao Tấn Phước :142.57±47.39 (third hour)
Cù Tuyết Anh: the fourth hour: 27,6%.
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Risk factors of intradialytic hypotension
Age
Age
(year)
Total of
patients
Number of
HD times
Number of
hypotension
Hypotensive
rate (%)p
1 < 30 10 232 6 2,6
2 31 - 40 14 328 16 4,9
3 41 - 50 16 376 22 5,8
4 51 - 60 18 424 21 4,9
5 > 60 12 280 19 6,8 p(1&5<0,05)
Total 70 1640 84 5,1
Nguyễn Minh Tuấn : 44% in patients ≥ 65 years old
Santoro: age > 60: 25%.
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Dialysis period
Dialysis period
(month)
Total of
patients
Total of
dialysis
Number of
hypotension
Hypotensive
rate (%)p
1 - 6 10 232 15 6,4 > 0,05
7 - 12 6 136 6 4,4 > 0,05
13 - 36 26 616 32 5,2 > 0,05
37 - 60 17 400 16 4,0 > 0,05
> 60 11 256 15 5,8 > 0,05
Total 70 1640 84 5,1
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Weight gain between 2 sessions
Weight gain
between 2 sessions
Total of
dialysis
Number of
hypotension
Hypotensive
rate (%)p
1 < 1,0kg 30 1 3,3
2 1,0 – 2,0kg 275 7 2,5
3 2,1 – 3,0 kg 743 41 5,5
4 > 3,0 kg 592 35 5,9 p(2&4<0,05)
Total 1640 84 5,1
Cù Tuyết Anh : gain >4 kg: hypotensive rate is17,2%.
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CONCLUSIONS
1. Intradialytic hypotensive rate and time:
- 17 patients had hypotension at least 1 time, making up 24%
- Number of hypotension was 84 times, making up 5,1%
- Hypotensive time: the fourth hour of dialysis process (p<0,05)
2. Risk factors of intradialytic hypotension:
- Age > 60: hypotensive rate was higher than group < 30 (p< 0,05)
- Weight gain between 2 sessions > 3kg: hypotensive rate was
higher than group of 1,0-2,0kg (p<0,05)
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PROPOSAL
• Patients were consulted about risks, dangers of
hypotensive complication.
• Nurse should have suitable caring plans and reduce
complications during dialysis process.
• To control weight gain between dialysis sessions and
limit excessive weight gain between 2 sessions (not
exceed 1kg within 2 - 3 days).
• Nurse must record vital signs every 15 -30 minutes,
especially at the ending hour in dialysis process
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THANK YOU !