Intradialytic Dopamine Therapy in Maintenance Hemodialysis Patients with Persistent Hypotension

使用Dopamine治療持續性透析中低血壓

邱文淵(Wen-Yuan Chiu) ； 張浤榮(Horng-Rong Chang) ； 林至展(Zyh-Zan Lin) ； 林文鶯(Enny Halim) ； 連榮達(Jong-Da Lian)

《Acta Nephrologica》 21卷1期 (2007/03) Pp. 22-29

摘要

Intradialytic hypotension (IDH) is a common and frustrating complication of hemodialysis. Certain hemodialysis patients persistently manifest this problem. Both patient-specific factors (autonomic insufficiency, cardiac dysfunction) and dialysis treatment-related factors (ultrafiltration, increased core temperature) are thought to have significant causative roles. A variety of maneuvers have been used for the treatment of IHD with variable success. However, there are still a subgroup of patients that suffer from IHD. We report our experience of 8 persistent IDH patients treated with intravenous dopamine infusion during a hemodialysis session. After dopamine was intravenously infused during the entire hemodialysis session, there were uniform improvements in the lowest intradialytic blood pressure, as well as the postdialytic blood pressure. Predialysis blood pressures were similar before and after dopamine therapy. The mean lowest intradialytic SBP (from 96.78±7.19 to 118.98±9.03mmHg, P＜0.001) and lowest intradialytic MAP (from 74.58±4.56 to 82.83±5.89mmHg, P＜0.001) were significantly better after dopamine therapy compared with before dopamine therapy. The same was true for the postdialysis SBP (from 124.24±11.06 to 132.85±6.25mmHg, P＜0.001), MAP (from 89.06±6.90 to 94.15±9.03mmHg, P＜0.001) and DBP (from 72.20±7.96 to 76.53±5.93mmHg, P＜0.001) after dopamine therapy compared with before dopamine therapy. The mean frequency of hypotension episodes significantly decreased following dopamine treatment (from 1.06±0.49 to 0.31±0.47/session, P＜0.001). The mean required Trendelenburg's position decreased from a mean of 0.79 time per dialysis session per patient to a mean of 0.14 time per dialysis session per patient following dopamine therapy (from 0.79±0.59 to 0.14±0.35/session, P＜0.001). The mean required saline infusion decreased from 136ml per dialysis session per patient to 34ml per dialysis per patient (from 136.07±54.85 to 34.81±52.72ml, P＜0.001). The mean required 50% glucose water infusion decreased from 8.0 to 2.25ml per dialysis session per patient (from 8.0±9.60 to 2.25±6.16ml, P＜0.001). Subjective symptoms of IHD improvement were found in all patients (4 marked, 2 moderate, 2 mild). Kt/V values before and after dopamine therapy were similar. The amount of fluid removal following dopamine therapy was higher than that before dopamine therapy to a statistically significant level (from 2.52±0.25 to 2.91±0.26Kg, P＜0.05). No significant adverse effects were noted. In summary, dopamine therapy for IDH patients during dialysis session seems to be effective and safe in this small number and short-period study.

關鍵字

透析中低血壓 ； dopamine

並列摘要

Intradialytic hypotension (IDH) is a common and frustrating complication of hemodialysis. Certain hemodialysis patients persistently manifest this problem. Both patient-specific factors (autonomic insufficiency, cardiac dysfunction) and dialysis treatment-related factors (ultrafiltration, increased core temperature) are thought to have significant causative roles. A variety of maneuvers have been used for the treatment of IHD with variable success. However, there are still a subgroup of patients that suffer from IHD. We report our experience of 8 persistent IDH patients treated with intravenous dopamine infusion during a hemodialysis session. After dopamine was intravenously infused during the entire hemodialysis session, there were uniform improvements in the lowest intradialytic blood pressure, as well as the postdialytic blood pressure. Predialysis blood pressures were similar before and after dopamine therapy. The mean lowest intradialytic SBP (from 96.78±7.19 to 118.98±9.03mmHg, P＜0.001) and lowest intradialytic MAP (from 74.58±4.56 to 82.83±5.89mmHg, P＜0.001) were significantly better after dopamine therapy compared with before dopamine therapy. The same was true for the postdialysis SBP (from 124.24±11.06 to 132.85±6.25mmHg, P＜0.001), MAP (from 89.06±6.90 to 94.15±9.03mmHg, P＜0.001) and DBP (from 72.20±7.96 to 76.53±5.93mmHg, P＜0.001) after dopamine therapy compared with before dopamine therapy. The mean frequency of hypotension episodes significantly decreased following dopamine treatment (from 1.06±0.49 to 0.31±0.47/session, P＜0.001). The mean required Trendelenburg's position decreased from a mean of 0.79 time per dialysis session per patient to a mean of 0.14 time per dialysis session per patient following dopamine therapy (from 0.79±0.59 to 0.14±0.35/session, P＜0.001). The mean required saline infusion decreased from 136ml per dialysis session per patient to 34ml per dialysis per patient (from 136.07±54.85 to 34.81±52.72ml, P＜0.001). The mean required 50% glucose water infusion decreased from 8.0 to 2.25ml per dialysis session per patient (from 8.0±9.60 to 2.25±6.16ml, P＜0.001). Subjective symptoms of IHD improvement were found in all patients (4 marked, 2 moderate, 2 mild). Kt/V values before and after dopamine therapy were similar. The amount of fluid removal following dopamine therapy was higher than that before dopamine therapy to a statistically significant level (from 2.52±0.25 to 2.91±0.26Kg, P＜0.05). No significant adverse effects were noted. In summary, dopamine therapy for IDH patients during dialysis session seems to be effective and safe in this small number and short-period study.

並列關鍵字

intradialytic hypotension ； dopamine