Intradialytic hypotension in haemodiafiltration and conventional haemodialysis

Abstract

Background: The fundamental objective of all dialysis therapies is the efficient cleansing of the blood from all uraemic toxins and fluid overload. The most frequent complication during haemodialysis is intradialytic hypotension. This poses a significant challenge because it can markedly impair patients’ long term and short term well- being, and impacts on the survival of the patients (Sherman, Daugirdas & Ing, 2007). In the past two decades, haemodiafiltration (HDF) has gained gradual clinical acceptance as an alternative to conventional haemodialysis (HD). It is now recognized as a safe, comfortable and efficient alternative to conventional haemodialysis in many countries across the world (Sichart, 2011). Objective: The aim of this review was to compare the effect of haemodiafiltration and conventional haemodialysis on intradialytic hypotension. The PICO question was “Is HDF better than conventional HD at managing intradialytic hypotension among dialysis patients?” Search Methods: Data sources included the Cochrane Central Register of Controlled Trials, Pubmed, Emerald e-journals, EBSCO and CinaHL. The inclusion criteria incorporated studies from systematic reviews and randomized controlled trials which enrolled adult, chronic dialysis patients receiving three times a week haemodialysis therapy and papers which were published in the English language only. Main Results: Two systematic reviews, five randomized controlled clinical trials and five crossover studies were identified. The evidence is inconclusive. The findings of a number of studies suggest that HDF may be more beneficial than HD. Four studies elicited no significant difference between the two therapies and two other studies reported that other factors such as body temperature control and sodium and/or fluid profiling may yield treatment benefits on the cardiovascular stability with one treatment over another. Conclusion: This review has indicated the need for further research upon this focus. Also, the need to establish updated guidelines and protocols of the haemodiafiltration procedure is indicated. These would ensure a consistent universal approach to the use of the therapy. In addition, education and training for workers and professionals in the field was indicated for in this review.