The changes in blood pressure, blood velocity, and hemoglobin level in patients with chronic kidney disease during hemodialysis
Main Article Content
Keywords
blood pressure; blood velocity; chronic renal failure; hemodialysis
Abstract
Introduction: Chronic kidney disease (CKD) is characterized by abnormal function and structure of the kidney, which occurs for more than 3 months with a decrease in glomerular filtration (less than 60ml/min/1.73 m2) and albuminuria. When the patients reach the state of end-stage renal failure, replacement therapy should be started, and most of these patients require a special procedure. Hemodialysis (HD), performed using the hemodialysis machine, acts as a filter for removal of waste and aqueous products from blood. In 20% of the HD sessions, a drop in blood pressure (BP) may occur due to dialysis.
Objective: To measure the effect of HD, BP, blood velocity (BV), and hemoglobin in Iraqi patients with CKD.
Method: A cross-sectional study was adopted to assess the effect of HD on blood volume and BP levels in Iraqi patients with CKD. The study was conducted at Al-Hussein Hospital in Thi-Qar province from December 1, 2019 to July 30, 2020, with the participation of 90 patients (50 males and 40 females). They were diagnosed as having CKD and taking regular treatment in addition to dialysis. The patients were divided into five age groups, and their ages ranged between 21 and 70 years. The study protocol included measuring BP with a sphygmomanometer and BV by Doppler study before and after dialysis.
Results: This study showed a significant change in BV and BP before and after HD.
Conclusion: Hypotension during hemodialysis seems to be common among patients with end-stage renal disease maintained on hemodialysis; thus, adequate monitoring of BP during dialysis process is essential to avoid any complications. It is also important to know at which hour of the dialysis the hypotension occurred to make a dialysis profile by changing the level of electrolyte on the dialysis set and changing the speed of hemofiltration. From the study, it was found that males are more liable to develop CKD. Thus, it is important that males with high risk factor for CKD, especially those with a history of diabetes and hypertension, do frequent follow-ups.
References
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20. Sars B, van der Sande FM, Kooman JP. A comparison of intradialytic versus out-of-clinic exercise training programs for hemodialysis
patients. Blood Purif. 2020;49(1–2):158–67. https://doi.org/10.1159/000503776
21. Roomi AB, Nori W, Hamed RM. Lower serum irisin levels are associated with increased osteoporosis and oxidative stress in
postmenopausal. Rep Biochem Mol Biol. 2021;10(1):13–9.https://doi.org/10.52547/rbmb.10.1.13
22. Assimon MM, Flythe JE. Definitions of intradialytic hypotension. Seminars Dial.2017;30(6):464–72. https://doi.org/10.1111/sdi.12626
23. Rocha A, Sousa C, Teles P, Coelho A, Xavier E. Effect of dialysis day on intradialytic hypotension risk. Kidney Blood Pressure Res. 2016;41(2):168–74. https://doi.org/10.1159/000443418
24. Salih AH, Waleed SM, Aziz AA, Hussien YA. The impact of hemodialysis on the blood velocity, blood pressure and hemoglobin in patients with chronic renal failure. Nat Volatiles Essential Oils J. 2021:5719–23. https://doi.org/10.1159/000486231
25. Kuipers J, Verboom LM, Ipema KJ, Paans W, Krijnen WP, Gaillard CA, et al. The prevalence of intradialytic hypotension in patients on
conventional hemodialysis: A systematic review with meta-analysis. Am J Nephrol. 2019;49(6):497–506. https://doi.org/10.1159/000500877
26. Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, et al. An update review of intradialytic hypotension: Concept, risk factors,
clinical implications and management. ClinKidney J. 2020;13(6):981–93. https://doi.org/10.1093/ckj/sfaa078
27. Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in
hemodialysis patients. Kidney Int. 2004;66(3):1212–20.https://doi.org/10.1111/j.1523-1755.2004.00812.x
28. Roomi AB, Nori W, Al-Badry SH. The value of serum adiponectin in osteoporotic women: Does weight have an effect? J Obes.
2021;2021:5325813.https://doi.org/10.1155/2021/5325813
29. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: Determinants and associated outcomes. Clin J Am
Soc Nephrol. 2009;4(5):914–20. https://doi.org/10.2215/CJN.03900808
30. MacEwen C, Sutherland S, Daly J, Pugh C, Tarassenko L. Relationship between hypotension and cerebral ischemia during hemodialysis. J AmSoc Nephrol. 2017;28(8):2511–20. https://doi.org/10.1681/ASN.2016060704
31. Seong EY, Zheng Y, Winkelmayer WC, MontezRath ME, Chang TI. The relationship between intradialytic hypotension and hospitalized
mesenteric ischemia: A case-control study. Clin JAm Soc Nephrol. 2018;13(10):1517–25.https://doi.org/10.2215/CJN.13891217
32. Roomi AB, Mahdi Salih AH, Noori SD, Nori W, Tariq S. Evaluation of bone mineral density, serum osteocalcin, and osteopontin levels in
postmenopausal women with type 2 diabetes mellitus, with/without osteoporosis. J Osteoporos. 2022;2022:1437061. https://doi.org/10.1155/2022/1437061
33. Elliot SJ, Karl M, Berho M, Potier M, Zheng F, Leclercq B, et al. Estrogen deficiency accelerates progression of glomerulosclerosis in susceptible mice. Am J Pathol. 2003;162(5):1441–8. https://doi.org/10.1016/S0002-9440(10)64277-0
34. Silbiger S, Neugarten J. Gender and human chronic renal disease. Gender Med. 2008;5:S3–10. https://doi.org/10.1016/j.genm.2008.03.002
35. Cobo G, Hecking M, Port FK, Exner I, Lindholm B, Stenvinkel P, et al. Sex and gender differences in chronic kidney disease: Progression to endstage renal disease and haemodialysis. Clin Sci. 2016;130(14):1147–63. https://doi.org/10.1042/CS20160047
36. Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: A 10-year populationbased study of the effects of gender and age. Kidney international. 2006 Jan 2;69(2):375–82.https://doi.org/10.1038/sj.ki.5000058
37. Coresh MD. J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–47. https://doi.org/10.1001/jama.298.17.2038
38. Dinesh K, Kunaparaju S, Cape K, Flythe JE, Feldman HI, Brunelli SM. A model of systolic blood pressure during the course of dialysis and
clinical factors associated with various blood pressure behaviors. Am J Kidney Dis. 2011;58(5):794–803. https://doi.org/10.1053/j.ajkd.2011.05.028
39. van der Sande FM, Dekker MJ, Leunissen KM, Kooman JP. Novel insights into the pathogenesis and prevention of intradialytic hypotension. Blood Purif. 2018;45(1–3):230–5.https://doi.org/10.1159/000485160
40. Sars B, van der Sande FM, Kooman JP. Intradialytic hypotension: Mechanisms and outcome. Blood Purif. 2020;49(1–2):158–67.
https://doi.org/10.1159/000503776
41. Ugawa T, Sakurama K, Yorifuji T, Takaoka M, Fujiwara Y, Kabashima N, et al. Evaluating the need for and effect of percutaneous transluminal angioplasty on arteriovenous fistulas by using total recirculation rate per dialysis session (“clearance gap”). Acta Med Okayama. 2012;66(6):443–7. https://doi.org/10.1111/j.1744-9987.2006.00410.x
42. Ogawa T, Matsumura O, Matsuda A, Hasegawa H, Mitarai T. Brachial artery blood flow measurement: A simple and noninvasive method to
evaluate the need for arteriovenous fistula repair. Dial Transplant. 2011;40(5):206–10. https://doi.org/10.1002/dat.20565
hemodialysis at selected hospital, Kanchipuram. Int J Nurs Edu Res. 2014;2(3):241–44.
2. Joudah MT, Saleh SM, Joudah WT, Joudah MT. Biochemical investigation to determine the factors involved in renal failure formation for
dialysis patients. Res J Pharm Technol. 2021;14(12):6275. https://doi.org/10.52711/0974-360X.2021.01085
3. Sathyanarayanan G, Shanmugasundaram P, Geetha P. A prospective observational study on microalbuminuria as risk factor of chronic renal
failure in patients with type 2 diabetes. Res JPharm Technol. 2017;10(9):3085–8. https://doi.org/10.5958/0974-360X.2017.00547.9
4. Vijaya Kumar S, Sasi Kala M, Garg S, Sharan G, Deka MK. A prospective study of aetiology, pathogenesis, management and outcome of acute renal failure. Res J Pharm Technol. 2010;3(2):327–32.
5. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238–52. https://doi.org/10.1016/S0140-6736(16)32064-5
6. Alghamdi AA, Almotairy KA, Aljoaid RM, Al Turkistani NA, Domyati RW, Abdelrahman MM, et al. The impact of a pre-dialysis educational
program on the mode of renal replacement therapy in a Saudi hospital: A retrospective cohort study. Cureus. 2020;12(12):e11981.
https://doi.org/10.7759/cureus.11981
7. Senthilkumar S, Dhivya K. Prognostic potential of serum biomarkers as predictors for cardiovascular complications and disease
progression in chronic kidney disease patients. Res J Pharm Technol. 2016;9(3):227–34. https://doi.org/10.5958/0974-360X.2016.00041.X
8. Hussien YA, Abdalkadim H, Mahbuba W, Hadi NR, Jamil DA, Al-Aubaidy HA. The nephroprotective effect of lycopene on renal ischemic reperfusion injury: A mouse model. Indian J Clin Biochem. 2020;35(4):474–81. https://doi.org/10.1007/s12291-019-00848-7
9. Sharma D, Mehta DK, Bhatti K, Das R, Chidurala RM. Amlodipine and atenolol: Combination therapy versus monotherapy in reducing blood
pressure—A focus on safety and efficacy. Res JPharm Technol. 2020;13(6):3007–13. https://doi.org/10.5958/0974-360X.2020.00532.6
10. Suganya V, Firdous J, Karpagam T, Varalakshmi B, Shanmugapriya A, Gomathi S, et al. Genotyping of angiotensin converting enzyme
(ACE 1) gene in study subject with hypertension and chronic kidney disease. Res J Pharm Technol. 2017;10(8):2607–10. 10.5958/0974-
360X.2017.00462.0
11. Roomi AB, Widjaja G, Savitri D, Turki Jalil A, Fakri Mustafa Y, Thangavelu L, et al. SnO2: Au/carbon quantum dots nanocomposites:
Synthesis, characterization, and antibacterial activity. J Nanostruct. 2021;11(3):514–23.10.22052/JNS.2021.03.009
12. Sarhat ER, Saeed HS, Wadi SA. Altered serum markers of omentin and chemerinin chronic renal failure patients on hemodialysis. Res J PharmTechnol. 2018;11(4):1667–70. 10.5958/0974-360X.2018.00310.4.
13. Roomi AB, AL-Salih RM, Ali SA. The effect insulin therapy and metformin on osteoporosis in diabetic postmenopausal Iraqi women. Indian J
Public Health. 2019;10(4):1479.
14. Elphick E, Holmes M, Tabinor M, Cho Y, Nguyen T, Harris T, et al. Outcome measures for technique survival reported in peritoneal dialysis:
A systematic review. Perit Dial Int. 2021;42(3):279–87.https://doi.org/10.1177/0896860821989874
15. Roomi AB, AL-Salih RM, Ali SA. Impact metformin and insulin therapy on parathyroid hormone and 25 (OH) vitamin D in diabetic postmenopausal Iraqi women. J Phys.2019;1279(1):012008.
16. Kang M, Kim YL, Kang E, Ryu H, Kim YC, Kim DK, et al. Evolving outcomes of peritoneal dialysis: Secular trends at a single large center
over three decades. Kidney Res Clin Pract. 2021;40(3):472–83.https://doi.org/10.23876/j.krcp.21.020
17. Hu PJ, Chen YW, Chen TT, Sung LC, Wu MY, Wu MS. Impact of dialysis modality on major adverse cardiovascular events and all-cause
mortality: A national population-based study. Nephrol Dial Transplant. 2021;36(5):901–8. https://doi.org/10.1093/ndt/gfaa282
18. Collins AJ, Weinhandl E, Snyder JJ, Chen SC, Gilbertson D. Comparison and survival of hemodialysis and peritoneal dialysis in the
elderly. Seminars Dial. 2002;15(2):98–102. https://doi.org/10.1046/j.1525-139x.2002.00032.x
19. Sands JJ, Usvyat LA, Sullivan T, Segal JH, Zabetakis P, Kotanko P, et al. Intradialytic hypotension: Frequency, sources of variation and
correlation with clinical outcome. Hemodial Int. 2014;18(2):415–22.https://doi.org/10.1111/hdi.12138
20. Sars B, van der Sande FM, Kooman JP. A comparison of intradialytic versus out-of-clinic exercise training programs for hemodialysis
patients. Blood Purif. 2020;49(1–2):158–67. https://doi.org/10.1159/000503776
21. Roomi AB, Nori W, Hamed RM. Lower serum irisin levels are associated with increased osteoporosis and oxidative stress in
postmenopausal. Rep Biochem Mol Biol. 2021;10(1):13–9.https://doi.org/10.52547/rbmb.10.1.13
22. Assimon MM, Flythe JE. Definitions of intradialytic hypotension. Seminars Dial.2017;30(6):464–72. https://doi.org/10.1111/sdi.12626
23. Rocha A, Sousa C, Teles P, Coelho A, Xavier E. Effect of dialysis day on intradialytic hypotension risk. Kidney Blood Pressure Res. 2016;41(2):168–74. https://doi.org/10.1159/000443418
24. Salih AH, Waleed SM, Aziz AA, Hussien YA. The impact of hemodialysis on the blood velocity, blood pressure and hemoglobin in patients with chronic renal failure. Nat Volatiles Essential Oils J. 2021:5719–23. https://doi.org/10.1159/000486231
25. Kuipers J, Verboom LM, Ipema KJ, Paans W, Krijnen WP, Gaillard CA, et al. The prevalence of intradialytic hypotension in patients on
conventional hemodialysis: A systematic review with meta-analysis. Am J Nephrol. 2019;49(6):497–506. https://doi.org/10.1159/000500877
26. Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, et al. An update review of intradialytic hypotension: Concept, risk factors,
clinical implications and management. ClinKidney J. 2020;13(6):981–93. https://doi.org/10.1093/ckj/sfaa078
27. Shoji T, Tsubakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in
hemodialysis patients. Kidney Int. 2004;66(3):1212–20.https://doi.org/10.1111/j.1523-1755.2004.00812.x
28. Roomi AB, Nori W, Al-Badry SH. The value of serum adiponectin in osteoporotic women: Does weight have an effect? J Obes.
2021;2021:5325813.https://doi.org/10.1155/2021/5325813
29. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: Determinants and associated outcomes. Clin J Am
Soc Nephrol. 2009;4(5):914–20. https://doi.org/10.2215/CJN.03900808
30. MacEwen C, Sutherland S, Daly J, Pugh C, Tarassenko L. Relationship between hypotension and cerebral ischemia during hemodialysis. J AmSoc Nephrol. 2017;28(8):2511–20. https://doi.org/10.1681/ASN.2016060704
31. Seong EY, Zheng Y, Winkelmayer WC, MontezRath ME, Chang TI. The relationship between intradialytic hypotension and hospitalized
mesenteric ischemia: A case-control study. Clin JAm Soc Nephrol. 2018;13(10):1517–25.https://doi.org/10.2215/CJN.13891217
32. Roomi AB, Mahdi Salih AH, Noori SD, Nori W, Tariq S. Evaluation of bone mineral density, serum osteocalcin, and osteopontin levels in
postmenopausal women with type 2 diabetes mellitus, with/without osteoporosis. J Osteoporos. 2022;2022:1437061. https://doi.org/10.1155/2022/1437061
33. Elliot SJ, Karl M, Berho M, Potier M, Zheng F, Leclercq B, et al. Estrogen deficiency accelerates progression of glomerulosclerosis in susceptible mice. Am J Pathol. 2003;162(5):1441–8. https://doi.org/10.1016/S0002-9440(10)64277-0
34. Silbiger S, Neugarten J. Gender and human chronic renal disease. Gender Med. 2008;5:S3–10. https://doi.org/10.1016/j.genm.2008.03.002
35. Cobo G, Hecking M, Port FK, Exner I, Lindholm B, Stenvinkel P, et al. Sex and gender differences in chronic kidney disease: Progression to endstage renal disease and haemodialysis. Clin Sci. 2016;130(14):1147–63. https://doi.org/10.1042/CS20160047
36. Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: A 10-year populationbased study of the effects of gender and age. Kidney international. 2006 Jan 2;69(2):375–82.https://doi.org/10.1038/sj.ki.5000058
37. Coresh MD. J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–47. https://doi.org/10.1001/jama.298.17.2038
38. Dinesh K, Kunaparaju S, Cape K, Flythe JE, Feldman HI, Brunelli SM. A model of systolic blood pressure during the course of dialysis and
clinical factors associated with various blood pressure behaviors. Am J Kidney Dis. 2011;58(5):794–803. https://doi.org/10.1053/j.ajkd.2011.05.028
39. van der Sande FM, Dekker MJ, Leunissen KM, Kooman JP. Novel insights into the pathogenesis and prevention of intradialytic hypotension. Blood Purif. 2018;45(1–3):230–5.https://doi.org/10.1159/000485160
40. Sars B, van der Sande FM, Kooman JP. Intradialytic hypotension: Mechanisms and outcome. Blood Purif. 2020;49(1–2):158–67.
https://doi.org/10.1159/000503776
41. Ugawa T, Sakurama K, Yorifuji T, Takaoka M, Fujiwara Y, Kabashima N, et al. Evaluating the need for and effect of percutaneous transluminal angioplasty on arteriovenous fistulas by using total recirculation rate per dialysis session (“clearance gap”). Acta Med Okayama. 2012;66(6):443–7. https://doi.org/10.1111/j.1744-9987.2006.00410.x
42. Ogawa T, Matsumura O, Matsuda A, Hasegawa H, Mitarai T. Brachial artery blood flow measurement: A simple and noninvasive method to
evaluate the need for arteriovenous fistula repair. Dial Transplant. 2011;40(5):206–10. https://doi.org/10.1002/dat.20565
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Feb 6, 2023
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Abdul-Hassan Mahdi Salih, Saad Mashkoor Waleed, Abdul-Aziz Ahmed Aziz, & Yasmeen Ali Hussien. (2023). The changes in blood pressure, blood velocity, and hemoglobin level in patients with chronic kidney disease during hemodialysis. Journal of Population Therapeutics and Clinical Pharmacology, 30(1), 225–232. https://doi.org/10.47750/jptcp.2023.1044
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