Dialysis Termination and Dialysis Dose in Severe Intra-Dialytic Hypotension Managed with Inotropic Support in a Low Income Setting

Abstract

Background: Intradialytic Hypotension (IDH) still remains a major complication and burden, and is associated with inadequate dose, poor quality of life, increased morbidity and mortality. Inotropic support could minimize dialysis termination and improve the dialysis dose. Objective: To determine the impact of inotropic support on the incidence of dialysis termination (a common finding in resource limited settings), and the dialysis dose. Materials and Methods: This retrospective, observational study compared the dialysis outcome in severe IDH with, and without dopamine treatment. Results: The 36 participants had 518 sessions with IDH, of this, 405 (78.19%) were without dopamine while 113 (21.81%), with severe IDH, were managed with dopamine. The mean ages of participants in the two groups were not significantly different, P=0.05. The risk of severe IDH was negatively related to the predialysis systolic blood pressure (SBP) P=0.03 while the postdialysis. Blood pressure was higher in dopamine treated sessions (DTSs). The blood flow rate (BFR) and dialysis dose were higher in the DTSs (P=0.05) and (P=0.04), but the dialysis dose was lower with anemia (P<0.001), metabolic acidosis (P<0.001), heart failure (0.04) and diabetes (P=0.04). In DTSs, females were more likely to have lower dialysis doses, (P=0.02). Independent associates of inadequate dialysis dose were infrequent dialysis sessions, infrequent erythropoietin doses, metabolic acidosis and anemia. Conclusion: Managing severe intradialytic hypotension with low dose dopamine is associated with reduced frequency of dialysis termination and augmentation of the dialysis dose. Reductions in the intradialytic BP gradients could minimize the complications associated with wide intradialytic BP variations. Keywords: Inotropic support, Dopamine, Severe intradialytic hypotension, Dialysis dose, Dialysis termination, Tachycardia, Heart failure, Blood flow rate.